Three-dimensional return map: a new tool for quantification of heart rate variability.

Autor: Moraes RS; Cardiology Division, Hospital de Clínicas de Porto Alegre, RS, Brazil., Ferlin EL, Polanczyk CA, Rohde LE, Zaslavski L, Gross JL, Ribeiro JP
Jazyk: angličtina
Zdroj: Autonomic neuroscience : basic & clinical [Auton Neurosci] 2000 Sep 01; Vol. 83 (1-2), pp. 90-9.
DOI: 10.1016/S0165-1838(00)00095-3
Abstrakt: Background: Several methods are used to study heart rate variability, but they have limitations, which might be overcome by the use of a three-dimensional return map.
Objectives: To evaluate the performance of three-dimensional return map-derived indices to detect (1) sympathetic and parasympathetic modulation to the sinus node and (2) autonomic dysfunction in diabetic patients.
Methods: Six healthy subjects underwent partial and total pharmacological autonomic blockade in a protocol that incorporated vagal and sympathetic predominance. Twenty-two patients with type 2 diabetes mellitus and 12 normal controls participated in the subsequent validation experiment. Three-dimensional return maps were constructed by plotting RRn intervals versus the difference between adjacent RR intervals [(RRn+1)-(RRn)] versus the number of counts, and four derived indices (P1, P2, P3, MN) were created for quantification.
Results: Both indices P1 and MN were significantly increased after sympathetic blockade with propranolol, while all indices except P1 were modified after parasympathetic blockade (P < 0.05). During the validation experiments, P1 and MN detected differences between normal controls, and diabetic patients with and without autonomic neuropathy. The overall accuracy of most three-dimensional indices to detect autonomic dysfunction, estimated by the area under the ROC curve, was significantly better than traditional time domain indices. Three-dimensional return map-derived indices also showed adequate reproducibility on two different recording days (intra-class correlation coefficients of 0.69 to 0.82; P < 0.001).
Conclusions: Three-dimensional return map-derived indices are reproducible, quantify parasympathetic as well as sympathetic modulation to the sinus node, and are capable of detecting autonomic dysfunction in diabetic patients.
Databáze: MEDLINE
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