Simultaneous Heart Rate Variability Monitoring Enhances the Predictive Value of Flow-Mediated Dilation in Ischemic Heart Disease
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概要
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Background: Endothelial dysfunction and autonomic nervous system imbalance are both risk markers of atherosclerotic vascular damage. The relationship between these 2 factors, however, has not been clarified concisely. Methods and Results: Flow-mediated dilation (FMD) was measured in 47 patients with ischemic heart disease (IHD; mean age, 68.1±7.1 years) using an ultrasound semi-automatic measuring system (UNEXEF18G), and autonomic nervous system activity was evaluated by simultaneous measurements of heart rate variability. FMD was significantly correlated with standard deviation of normal-to-normal beats (r=0.33, P=0.022) and the power ratio of low-frequency power to high-frequency power (LF/HF; r=–0.38, P=0.0087). Furthermore, multiple regression analysis indicated that LF/HF was the most important predictor of the magnitude of FMD. This interaction was severely blunted by β-blockers and the presence of diabetes. Moreover, standardized FMD according to autonomic nervous system activity was a better predictor of future cardiovascular events than FMD. Subjects with cardiovascular events had a significantly smaller corrected FMD (event (+), 3.62±0.41; event (–), 5.10±2.35; P=0.001), and the higher corrected FMD was associated with longer event-free survival. Conclusions: Autonomic nervous system activity is an important regulatory factor of FMD in subjects with IHD. Assessment of this interaction can help provide more accurate risk stratification of subjects with IHD. (Circ J 2013; 77: 1018–1025)
著者
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Nakao Tomoko
Department Of Cardiovascular Medicine Graduate School Of Medicine University Of Tokyo
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Amiya Eisuke
Department Of Cardiovascular Medicine University Of Tokyo
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Hosoya Yumiko
Department Of Cardiology Sakakibara Heart Institute Japan Research Promotion Society For Cardiovascu
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Maemura Koji
Department Of Cardiovascular Medicine Course Of Medical And Dental Sciences Graduate School Of Biome
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Watanabe Masafumi
Department Of Cardiovascular Medicine Graduate School Of Medicine The University Of Tokyo
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Komuro Issei
Department Of Cardiovascular Medicine
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KOMURO Issei
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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KAWARASAKI Shuichi
Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
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Watanabe Aya
Department of Chemistry and Chemical Biology, Graduate School of Engineering, Gunma University
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OZEKI Atsuko
Department of Cardiovascular Medicine, Graduate School of Medicine, the University of Tokyo
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Nagai Ryozo
Jichi Medical School
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Watanabe Shogo
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
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Takata Munenori
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
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Omori Kazuko
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
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Hosoya Yumiko
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
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Kawarasaki Shuichi
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
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