Evaluation of Heart Rate Variability Parameters in Congestive Heart Failure and Atrial Fibrillation Patients.

Yıl 2024, , 287 - 294, 30.09.2024

Hasan Kazdağlı , Hasan Fehmi Özel

https://doi.org/10.34087/cbusbed.1367983

Öz

Objective: Sudden cardiac death constitutes a significant portion of mortality in patients with congestive heart failure (KKY) and atrial fibrillation (AF). Numerous parameters are utilized to predict the risk of sudden death. However, heart rate variability (KHD) stands out as a method with high predictive power, low cost, and non-invasive measurement for estimating this risk. Certain KHD parameters have provided independent prognostic information in KKY patients. In this study, we aimed to compare HRV parameters in individuals with normal sinus rhythm, congestive heart failure (CHF), and atrial fibrillation (AF) patients to demonstrate which parameters would be more accurate to use in these patients.
Results: It was observed that in the AF group, the average heart rate, standard deviation of the NN intervals (SDNN), and the square root of the mean squared differences of successive NN intervals (RMSSD) were higher compared to the NSR and KKY groups. However, the stress index was lower in the AF group. In terms of frequency-domain parameters, very low frequency (VLF) was found to be higher in the NSR group compared to the other groups, while the sympathovagal balance increased in the KKY and AF groups compared to the NSR group. In nonlinear analyses, DFAα1 was observed to be higher in the KKY and AF groups compared to the NSR group.
Conclusion: Our findings suggest that linear KHD parameters yield less reliable results in AF patients. These findings indicate that KHD parameters could be an important tool for risk classification in individuals with sinus rhythm; however, further research, particularly the development of nonlinear analysis methods, is needed for individuals without sinus rhythm.

Anahtar Kelimeler

heart rate, heart rate variability, atrial fibrillation, congestive hearf failure, nonlinear analyses, sinus ritm

Konjestif Kalp Yetmezliği ve Atriyal Fibrilasyon Hastalarında Kalp Atım Hızı Değişkenliği Parametrelerinin Değerlendirilmesi.

Öz

Giriş ve Amaç: Konjestif kalp yetmezliği (KKY) ve atriyal fibrilasyon (AF) hastalarında ani kardiyak ölüm, bu hastalardaki ölümlerin önemli bir kısmını oluşturur. Ani ölüm riskini tahmin etmek için birçok parametre kullanılmaktadır. Ancak kalp atım hızı değişkenliği (KHD), yüksek tahmin gücü, düşük maliyet ve girişimsel olmayan bir ölçüm yöntemi olarak öne çıkmaktadır. Bazı KHD parametreleri, KKY hastalarında bağımsız prognostik bilgi sağlamıştır. Biz de bu çalışmada normal sinüs ritme sahip bireylerde, konjestif kalp yetmezliği (KKY) ve AF hastalarında KHD parametrelerini karşılaştırarak, bu hastalarda hangi parametreleri kullanmanın daha doğru olacağını göstermeyi amaçladık.
Gereç ve Yöntemler: Çalışmamızda, Physionet Elektrokardiyografi (EKG) veritabanları kullanıldı. Kayıtlar üç grupta incelendi: Normal Sinüs Ritmi (NSR, n=18), Konjestif Kalp Yetersizliği (KKY, n=30) ve Atriyal Fibrilasyon (AF, n=30). KHD analizleri ile zaman-tabanlı, frekans-tabanlı ve doğrusal olmayan parametreler elde edildi. Tüm gruplar arasında doğrusal olmayan parametrelerin varyasyonlarını test etmek için parametrik olmayan bağımsız örnekler Kruskal Wallis testi, Dunn düzeltmesi ile birlikte kullanıldı. İstatistiksel anlamlılık düzeyi p < 0,05 olarak kabul edildi.
Bulgular: Zaman-tabanlı parametreler incelendiğinde, AF grubunda ortalama kalp hızı, Atımlar arasındaki mesafenin standart sapması (SDNN), bu standart sapmanın karekök ortalaması (RMSSD)'nın NSR ve KKY gruplarına göre yüksek olduğu görüldü. Stres endeksi ise AF grubunda daha düşüktü. Frekans-tabanlı parametrelerde ise NSR grubunda çok düşük frekans (VLF)'ın diğer gruplara göre yüksek olduğu, sempatovagal dengenin ise KKY ve AF gruplarında, NSR grubuna göre arttığı görüldü. Doğrusal olmayan analizlerde DFAα1’in KKY ve AF gruplarında NSR grubuna göre arttığı gözlemlendi.
Sonuç: Bulgularımız, doğrusal KHD parametrelerinin AF hastalarında, daha az güvenilir sonuçlar gösterdiğini ortaya koymaktadır. Bu bulgular, KHD parametrelerinin sinüs ritme sahip bireylerde risk sınıflandırması için önemli bir araç olabileceğini ancak, sinüs ritme sahip olmayan bireylerde daha fazla araştırma ve özellikle doğrusal olmayan analiz yöntemlerinin geliştirilmesi gerektiğini göstermektedir.

Anahtar Kelimeler

kalp atım hızı değişkenliği, atriyal fibrilasyon, konjestif kalp yetmezliği, doğrusal olmayan analizler, sinüs ritim, kalp hızı

Kaynakça

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