Changes and prognostic significance of autonomic cardiac regulation during ageing

IF 3.2 4区医学 Q2 NEUROSCIENCES

Autonomic Neuroscience-Basic & Clinical Pub Date : 2025-02-23 DOI:10.1016/j.autneu.2025.103255

Elisa Karhumaa, Antti Vuoti, Antti M. Kiviniemi, M. Juhani Junttila, Mikko P. Tulppo, Heikki V. Huikuri, Olavi H. Ukkola, Juha S. Perkiömäki

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Abstract

Background

Data on the changes of heart rate variability (HRV) and their prognostic significance during ageing are limited.

Methods

HRV analyzes were done from standardized 45-min ECG recordings, which consisted of 15 min recordings in lying down, sitting positions and during walking. We used time domain-, frequency domain- and non-linear methods to estimate HRV. The baseline ECG recordings were done in 1991–1993 (n = 783) and follow up recordings were done in 2013–2014 (n = 466). Endpoints were reviewed in 2021.

Results

During a mean follow-up of 22.1 ± 0.7 years, high-, low- and very-low-frequency powers (HF, LF, VLF), standard deviation of RR intervals (SDNN), the short-term fractal-like scaling exponent analyzed by the detrended fluctuation analysis (DFA1) and approximate entropy (ApEn) decreased statistically significantly (p-values from <0.05 to <0.001). Larger decrease of VLF(ln) and LF(ln) predicted total and cardiovascular (CV) mortality in the multivariate model (p-values from <0.05 to <0.001). Baseline natural logarithm of LF (LF(ln)) dichotomized and DFA1 had the strongest prognostic value on total and CV-mortality in multivariate analysis after adjustments with relevant clinical characteristics. Also, lower values of baseline ApEn retained their predictive power for total mortality and decreased ratio of LF to HF (LF/HF) for CV-mortality after adjustments.

Conclusions

Almost all the HRV parameters decreased during ageing. Larger decrease of VLF(ln) and LF(ln) predicted total and CV-mortality after adjustments indicating that larger attenuation in cardiac autonomic regulation during ageing yields prognostic information. Of the baseline HRV parameters LF(ln) dichotomized and DFA1 had the strongest prognostic value on total and CV-mortality.

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自律性心脏调节在衰老过程中的变化及其预后意义

随着年龄的增长，心率变异性（HRV）的变化及其预后意义的数据有限。方法采用标准化的45分钟心电图记录进行shrv分析，其中包括躺卧、坐位和行走时的15分钟记录。我们使用时域、频域和非线性方法来估计HRV。基线心电图记录于1991-1993年（n = 783），随访记录于2013-2014年（n = 466）。2021年对终点进行了审查。结果在平均22.1±0.7年的随访中，高、低、甚低频功率（HF、LF、VLF）、RR区间标准差（SDNN）、短期分形标度指数（DFA1）和近似熵（ApEn）均有统计学意义（p值从0.05 ~ 0.001）。在多变量模型中，VLF（ln）和LF（ln）的较大下降预测了总死亡率和心血管死亡率（CV）（p值从<；0.05到<；0.001）。在多因素分析中，经相关临床特征调整后，LF（ln）二分和DFA1的基线自然对数对总死亡率和cv死亡率的预测价值最强。此外，较低的基线ApEn值在调整后对总死亡率和降低的LF/HF比率（LF/HF）对cv死亡率的预测能力保持不变。结论随着年龄的增长，HRV参数几乎全部下降。调整后，VLF（ln）和LF（ln）的较大下降预测了总死亡率和cv死亡率，表明衰老过程中心脏自主调节的较大衰减提供了预后信息。在基线HRV参数中，LF（ln）二分化和DFA1对总死亡率和cv死亡率具有最强的预后价值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Autonomic Neuroscience-Basic & Clinical 医学-神经科学

CiteScore

5.80

自引率

7.40%

发文量

审稿时长

66 days

期刊介绍： This is an international journal with broad coverage of all aspects of the autonomic nervous system in man and animals. The main areas of interest include the innervation of blood vessels and viscera, autonomic ganglia, efferent and afferent autonomic pathways, and autonomic nuclei and pathways in the central nervous system. The Editors will consider papers that deal with any aspect of the autonomic nervous system, including structure, physiology, pharmacology, biochemistry, development, evolution, ageing, behavioural aspects, integrative role and influence on emotional and physical states of the body. Interdisciplinary studies will be encouraged. Studies dealing with human pathology will be also welcome.