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Revista chilena de cardiología

On-line version ISSN 0718-8560

Abstract

JERIA, Carolina; HERNANDEZ, Rodrigo  and  BENN, Claus. Alterations in heart rhythm variability in patients with non-ST segment elevation acute coronary syndromes: preliminary report. Rev Chil Cardiol [online]. 2011, vol.30, n.2, pp.104-112. ISSN 0718-8560.  http://dx.doi.org/10.4067/S0718-85602011000200003.

Background: Heart rhythm variability (HRV) is an indicator of autonomous nervous system modulation, which may be analyzed in both time and rate domains. A decrease in HRV following ST segment elevation acute myocardial infarction has been shown to be associated to increased cardiovascular mortality and ventricular arrhythmias. Aim: To evaluate whether a decreased HRV is correlated to myocardial damage markers (CK MB mass and Troponin t) in patients with a non-ST segment elevation acute coronary syndrome (NSTE-ACS) Methods: Patients with NSTE-ACS in sinus rhythm within 24 hours of admission were included. We excluded patients with prior MI, heart failure class III or IV, arrhythmias or severe co-morbidity. Clinical characteristics, CK MB mass and serum troponin levels were determined. HRV was measured in a 5 min recording using the Polar S810 monitor with the patient lying flat. The software HRV Analysis 1.1 was used to process HRV data. Results: 14 patients were studied. In comparison with normal reference values, HRV in the time domain was significantly decreased (RR 902 ± 23.4 ms; RMSSD 23.38 ms; pNN50 6%). Patients with positive myocardial damage markers exhibited altered HRV parameters in the frequency domain (high frequency: HF 22.7 ms2 p:0.008, low frequency: LF 66.9 u.n. p:0.016). Patients with high CK MB mass and elevated troponin levels had significantly lower high frequency values and significantly increased means for low frequency variables, compared to patients with normal CK MB mass and troponin levels. These findings reflect an increased sympathetic drive on HRV along with a decreased para-sympathetic regulation in these patients. Conclusion: Changes in 5 min recordings of HRV suggest a decreased activity of the para sympathetic system in patients with NSTE-ACS.

Keywords : rhythm variability; acute coronary syndrome.

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