The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Correlation of the left ventricular diastolic function and the heart rate variability in patients with acute myocardial infarction

급성심근경색증 환자에서 좌심실 이완기 기능과 심박수 변이성의 연관성

Joo, Seung-Jae;Kim, Ki-Seok;Yook, Dong-Seung;Lee, Jae-Woo
주승재;김기석;육동승;이재우

  • Published : 20050800
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Abstract

Background : Reduced heart rate varaibility (HRV) after acute myocardial infarction (AMI) is an important risk factor for mortality and life-threatening arrhythmias. The correlation between the left ventricular (LV) diastolic function and autonomic balance expressed by HRV in patients with AMI was evaluated in this study. Methods : A 2-dimensional and Doppler echocardiography and a 24-hour Holter monitoring were performed at 5th to 7th day after attack in 50 patients with AMI. The restrictive filling pattern of the LV diastolic function was defined by E/A ratio >2 or deceleration time (DT) of the mitral inflow $\leq$150 msec. Standard deviation of all NN intervals (SDNN), coefficients of variance (CV: SDNN/average of all NN intervals), standard deviation of the average of NN intervals in all 5-minute segments of the entire recording (SDANN), and other indexes of HRV were assessed using a 24 hour Holter monitoring. Results : DT correlated significantly with SDNN (r=0.53; p<0.001), CV (r=0.42; p=0.003), and SDANN (r=0.59; p<0.001). The patients with the restrictive filling pattern (n=10) had significantly lower SDNN (80$\pm$14 vs. 96$\pm$25 msec; p=0.044), CV (9.4$\pm$1.8 vs. 10.7$\pm$2.4%; p=0.012), and SDANN (61$\pm$11 vs. 79$\pm$24 msec; p=0.009) than those with non-restrictive filling pattern (n=40). Conclusion : Patients with the restrictive LV filling pattern after AMI had more reduced HRV than those with the non-restrictive filling pattern.

목적 : 급성심근경색증 후 심박수 변이성(heart rate variability)의 감소는 사망과 치명적인 부정맥 발생의 위험 인자이다. 또한 좌심실 수축기 기능과 이완기 기능은 급성심근경색증 후 예후를 예측할 수 있는 중요한 인자들이며 특히 좌심실 이완기 기능이 제한성장애인 경우 예후가 불량하다. 이 연구에서는 급성심근경색증 후 좌심실 이완기 기능과 심박수 변이성의 지표들 사이의 연관성을 밝히고자 하였다. 방법 : 급성심근경색증 환자 50명을 대상으로 발병 5$\sim$7일 사이에 경흉부 심초음파 검사와 24시간 활동 중 심전도 검사를 시행하였다. 심초음파 검사에서 좌심실 구혈률, 국소벽운동지수, 좌심실 유입 혈류의 E/A 비, 감속 시간 등을 구하였고, 감속 시간이 150 msec 이하이거나 E/A 비가 2 이상인 경우 제한성장애로 진단하였다. 24시간 활동 중 심전도 검사에서 standard deviation of all NN intervals (SDNN), coefficients of variance (CV: SDNN/average of all NN intervals), standard deviation of the average of NN intervals in all 5-minute segments of the entire recording (SDANN) 등을 구하였다. 결과 : 감속 시간과 SDNN (r=0.53; p<0.001), CV (r=0.42; p=0.003), SDANN (r=0.59; p<0.001) 사이에 유의한 양의 상관관계가 있었다. 제한성장애가 있는 환자의 SDNN (80$\pm$14 vs. 96$\pm$25 msec; p=0.044), CV (9.4$\pm$1.8 vs. 10.7$\pm$2.4%; p=0.012), SDANN (61$\pm$11 vs. 79$\pm$24 msec; p=0.009) 등이 유의하게 감소되어 있었다. 결론 : 급성심근경색증 후 좌심실 이완기 기능이 제한성 장애인 경우 그렇지 않은 환자에 비해서 심박수 변이성이 감소되어 있었다.

Keywords

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