Otonom Disfonksiyon Parameterleri ile Efor Testi Sırasında İzlenen Ventriküler Erken Vuru Sıklığı ve İskemik ST-segment Değişikliği Varlığı Arasındaki İlişki

Giriş-amaç: Vagal reaktivasyon normal olarak egzersiz sonrası toparlanmanın erken döneminde meydana gelir. Normal vagal reaktivasyonun yokluğunda, kalp hızı toparlanması (HRR) zayıflar. Kalp hızı türbülansı (HRT), ventriküler ektopiden sonra arteriyel kan basıncındaki bozulmalara verilen otonomik yanıtın bir göstergesidir. HRR ve HRT'nin (türbülans başlangıcı (TO) ve türbülans eğimi (TS)) prognostik rolü iyi bilinmektedir. Bu çalışmada, egzersiz testi sırasında ventriküler ektopi sıklığı ve iskemik ST-segment değişikliği varlığı ile bu parametreler arasında bir ilişki olup olmadığını araştırmayı amaçladık. Yöntemler: Koroner arter hastalığı ya da kalp yetmezliği olmayan 1550 hastadan 100'ünde (%6,4) ezgersiz sonrası toparlanma sırasında ventriküler ektopi vardı. Bu hastalarda ventriküler ektopi sıklığı, egzersiz sonrası 1. dakikadaki HRR indeksi, TO ve TS değerlerini ölçtük. Bulgular: Hastaların %35'inde TO, %17'sinde TS ve %10'unda HRR anormaldi ve TO daha önce bozulmuştu. Hastalar iskemik ST-segment değişikliklerine göre (negatif ve pozitif) gruplandırıldığında; yaş, maksimum METs, egzersiz süresi, TO, TS, TS normal/anormal, HRR, HRR normal/anormal, egzersiz veya toparlanma sırasında ventriküler ektopi sayısı, maksimum kalp hızı ve bazal kalp hızı gruplar arasında benzerdi. Egzersiz testi pozitif olanlarda TO anormal olma eğilimindeydi (p=0.07). HRR ile TS arasında hafif derecede anlamlı bir korelasyon gözlendi (r=0.21, p=0.036). Toparlanma sürecindeki ventriküler ektopi sayısı, egzersiz sırasındaki ventriküler ektopi sayısı ile korele idi. Ayrıca TS, kalp hızı TO ve HRR ile koreleydi. Sonuç: Düşük-orta riskli bireylerde, toparlanmanın 1. dakikasındaki HRR ve HRT’nin, otonomik fonksiyonun farklı yönlerini yansıtıyor olabilirler ve bunlar, egzersiz testi sırasındaki iskemik ST-segment değişikliği varlığı ve ventriküler ektopi sıklığı ile ilişkili değildi.

The Relationship between Autonomic Dysfunction Parameters and Ventricular Premature Complex Frequency and Presence of ischemic ST-segment Changes during Treadmill Exercise Test

Objectives: Vagal reactivation normally occurs in the early period of recovery, immediately after exercise. In the absence of normal vagal reactivation, heart-rate recovery (HRR) is attenuated. Heart rate turbulence (HRT) is an indicator of autonomic response to perturbations of arterial blood pressure after ventricular ectopy. The prognostic role of HRR and HRT (turbulence onset (TO) and turbulence slope (TS)) is well established. In this study, we aimed to investigate whether there is a relationship between these parameters and frequency of ventricular ectopies and ischemic ST-segment changes during exercise test. Methods: Of the 1550 patients without coronary artery disease or heart failure, 100 (6.4%) had ventricular ectopia during recovery from exercise. In these patients, we measured the frequency of ventricular ectopia during exercise and recovery, heart rate recovery index at first minute after exercise, TO and TS values. Results: TO was abnormal in 35% of patients, TS in 17% and HRR in 10%, and that TO was impaired earlier. When the patients were grouped according to ischemic ST-segment changes (negative and positive); age, maximum METs, duration of exercise, TO, TS, TS normal/abnormal, HRR, HRR normal/abnormal, number of ventricular ectopies during exercise or recovery, maximum heart rate and basal heart rate were similar between groups. Abnormal TO rate tended to be higher in those with positive exercise test. A mildly significant correlation was observed between HRR and TS (r=0.21, p=0.036). The number of ventricular ectopies in the recovery was correlated with the number of ventricular ectopies during exercise. TS was correlated with TO and HRR. Conclusion: In low-intermediate risk individuals, HRR at first minute of recovery and HRT may reflect different aspects of autonomic dysfunction and they were not associated with presence of ischemic ST-segment changes and frequency of ventricular ectopies during exercise test.

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