Predictive value of systolic pulmonary artery pressure on autonomic nerve excitation in 186 patients with valvular disease: A prospective study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YUE Fengjie ¹ ,  JIN Yan ² , ZHANG Yuji ² , XIN Fangran ² , WANG Huishan ²

1. Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, Hubei, P. R. China;
2. Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang, 110016, P. R. China;

Corresponding author：

JIN Yan, Email: 13309888850@163.com

Keywords：

Heart rate variability; echocardiography; systolic pulmonary artery pressure; autonomic nerve

DOI：

10.7507/1007-4848.202205008

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the predictive value of systolic pulmonary artery pressure (SPAP) on autonomic nerve excitation in patients with valvular disease, so as to provide reference for the formulation of clinical intervention plans. Methods The clinical data of patients with valvular disease who received surgical treatment in the General Hospital of Northern Theater Command from August 28, 2020 to February 3, 2021 were prospectively collected. According to the standard deviation of normal-to-normal R-R intervals (SDNN) of the heart rate variability (HRV) of the long-range dynamic electrocardiogram (ECG) 7 days before the operation, the patients were divided into three groups: a sympathetic dominant (SE) group (SDNN≤50 ms), a balance group (50 ms<SDNN<100 ms) and a parasympathetic dominant (PSE) group (SDNN≥100 ms). The correlation between the changes of echocardiographic indexes and autonomic nerve excitation among the groups and the predictive values were analyzed. Results A total of 186 patients were enrolled, including 108 males and 78 females aged 55.92±11.99 years. There were 26 patients in the SE group, 104 patients in the balance group, and 56 patients in the PSE group. The left anteroposterior diameter (LAD), left ventricular end diastolic inner diameter, ratio of peak E to peak A of mitral valve (Em/Am), left ventricular end diastolic volume, left ventricular end systolic volume and SPAP in the SE group were higher than those in the balance group (P<0.05), while peak A of tricuspid valve (At) and left ventricular ejection fraction (LVEF) were lower than those in the balance group (P<0.05). The LAD and Em/Am in the balance group were significantly higher than those in the PSE group (P<0.05). Multivariate analysis showed that patients in the SE group had lower At (right atrial systolic function declines), lower LVEF and higher SPAP than those in the balance group (P=0.04, 0.04 and 0.00). When HRV increased and parasympathetic nerve was excited in patients with valvular disease, Em/Am decreased (left atrial function and/or left ventricular diastolic function declined) with a normal LAD. Pearson analysis showed that there was a linear negative correlation between SPAP and SDNN, with a coefficient of −0.348, indicating that the higher SPAP, the lower HRV and the more excited sympathetic nerve. Receiver operating characteristic curve showed that when SPAP≥45.50 mm Hg (1 mm Hg=0.133 kPa), the sensitivity and specificity of sympathetic excitation in patients with valvular disease were 84.60% and 63.70%, respectively. Conclusion Parasympathetic excitation is an early manifestation of the disease, often accompanied by decreased left atrial function and/or left ventricular diastolic function. Sympathetic nerve excitation can be accompanied by the increase of SPAP and the decrease of left ventricular and right atrial systolic function. SPAP has a unique predictive value for the prediction of autonomic nerve excitation in patients with valvular disease.

Citation： YUE Fengjie, JIN Yan, ZHANG Yuji, XIN Fangran, WANG Huishan. Predictive value of systolic pulmonary artery pressure on autonomic nerve excitation in 186 patients with valvular disease: A prospective study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(2): 276-282. doi: 10.7507/1007-4848.202205008 Copy

1.	Yadgir S, Johnson CO, Aboyans V, et al. Global, regional, and national burden of calcific aortic valve and degenerative mitral valve diseases, 1990-2017. Circulation, 2020, 141(21): 1670-1680.
2.	Mrsic Z, Hopkins SP, Antevil JL, et al. Valvular heart disease. Prim Care, 2018, 45(1): 81-94.
3.	Taralov ZZ, Terziyski KV, Kostianev SS. Heart rate variability as a method for assessment of the autonomic nervous system and the adaptations to different physiological and pathological conditions. Folia Med (Plovdiv), 2015, 57(3-4): 173-180.
4.	Cygankiewicz I, Zareba W. Heart rate variability. Handb Clin Neurol, 2013, 117: 379-393.
5.	Johnston BW, Barrett-Jolley R, Krige A, et al. Heart rate variability: Measurement and emerging use in critical care medicine. J Intensive Care Soc, 2020, 21(2): 148-157.
6.	Fouradoulas M, von Känel R, Schmid JP. Heart rate variability: State of research and clinical applicability. Praxis (Bern 1994), 2019, 108(7): 461-468.
7.	Imai J, Katagiri H. Regulation of systemic metabolism by autonomic nerve-mediated inter-organ networks. Brain Nerve, 2021, 73(8): 851-856.
8.	郭继鸿. 三维心率变异性. 临床心电学杂志, 2016, 25(2): 141-153.
9.	Karaliute R, Jureviciute J, Jurgaityte J, et al. The predictive value of tissue doppler indices for early recurrence of atrial fibrillation after electrical cardioversion. Clin Interv Aging, 2020, 15: 1917-1925.
10.	Ari H, Ari S, Sarigül OY, et al. A novel index combining diastolic and systolic tissue doppler parameters for prediction of atrial fibrillation recurrence. Echocardiography, 2016, 33(7): 1009-1015.
11.	Nishimura RA, Tajik AJ. Quantitative hemodynamics by Doppler echocardiography: A noninvasive alternative to cardiac catheterization. Prog Cardiovasc Dis, 1994, 36(4): 309-342.
12.	Nishimura RA, Carabello B. Operationalizing the 2014 ACC/AHA guidelines for valvular heart disease: A guide for clinicians. J Am Coll Cardiol, 2016, 67(19): 2289-2294.
13.	Khan AA, Junejo RT, Thomas GN, et al. Heart rate variability in patients with atrial fibrillation and hypertension. Eur J Clin Invest, 2021, 51(1): e13361.
14.	Little JG, Bealer SL. β adrenergic blockade prevents cardiac dysfunction following status epilepticus in rats. Epilepsy Res, 2012, 99(3): 233-239.
15.	Mehta RH, Supiano MA, Grossman PM, et al. Changes in systemic sympathetic nervous system activity after mitral valve surgery and their relationship to changes in left ventricular size and systolic performance in patients with mitral regurgitation. Am Heart J, 2004, 147(4): 729-735.
16.	Draghici AE, Taylor JA. The physiological basis and measurement of heart rate variability in humans. J Physiol Anthropol, 2016, 35(1): 22.
17.	Brüler BC, Vieira TC, Wolf M, et al. Using the oculocardiac reflex to characterize autonomic imbalance in a naturally occurring canine model of valvular insufficiency. Comp Med, 2018, 68(2): 156-162.
18.	刘娟娟, 孙丹丹, 白洋, 等. 超声心动图评价肺动脉高压患者右房功能的研究进展. 临床超声医学杂志, 2019, 21(6): 443-445.
19.	Linssen PBC, Veugen MGJ, Henry RMA, et al. Associations of (pre)diabetes with right ventricular and atrial structure and function: The Maastricht study. Cardiovasc Diabetol, 2020, 19(1): 88.
20.	Khanji MY, Fung K, Donal E, et al. Impact of measurement variations in right atrial structure and function on outcomes. JACC Cardiovasc Imaging, 2019, 12(3): 569-570.
21.	Jin Y, Wang H, Wang Z, et al. The evaluation of preoperative right ventricular diastolic dysfunction on coronary artery disease patients with left ventricular dysfunction. Echocardiography, 2014, 31(10): 1259-1264.
22.	Liu C, Jiang XM, Zhang J, et al. Pulmonary artery denervation improves pulmonary arterial hypertension induced right ventricular dysfunction by modulating the local renin-angiotensin-aldosterone system. BMC Cardiovasc Disord, 2016, 16(1): 192.

1. Yadgir S, Johnson CO, Aboyans V, et al. Global, regional, and national burden of calcific aortic valve and degenerative mitral valve diseases, 1990-2017. Circulation, 2020, 141(21): 1670-1680.
2. Mrsic Z, Hopkins SP, Antevil JL, et al. Valvular heart disease. Prim Care, 2018, 45(1): 81-94.
3. Taralov ZZ, Terziyski KV, Kostianev SS. Heart rate variability as a method for assessment of the autonomic nervous system and the adaptations to different physiological and pathological conditions. Folia Med (Plovdiv), 2015, 57(3-4): 173-180.
4. Cygankiewicz I, Zareba W. Heart rate variability. Handb Clin Neurol, 2013, 117: 379-393.
5. Johnston BW, Barrett-Jolley R, Krige A, et al. Heart rate variability: Measurement and emerging use in critical care medicine. J Intensive Care Soc, 2020, 21(2): 148-157.
6. Fouradoulas M, von Känel R, Schmid JP. Heart rate variability: State of research and clinical applicability. Praxis (Bern 1994), 2019, 108(7): 461-468.
7. Imai J, Katagiri H. Regulation of systemic metabolism by autonomic nerve-mediated inter-organ networks. Brain Nerve, 2021, 73(8): 851-856.
8. 郭继鸿. 三维心率变异性. 临床心电学杂志, 2016, 25(2): 141-153.
9. Karaliute R, Jureviciute J, Jurgaityte J, et al. The predictive value of tissue doppler indices for early recurrence of atrial fibrillation after electrical cardioversion. Clin Interv Aging, 2020, 15: 1917-1925.
10. Ari H, Ari S, Sarigül OY, et al. A novel index combining diastolic and systolic tissue doppler parameters for prediction of atrial fibrillation recurrence. Echocardiography, 2016, 33(7): 1009-1015.
11. Nishimura RA, Tajik AJ. Quantitative hemodynamics by Doppler echocardiography: A noninvasive alternative to cardiac catheterization. Prog Cardiovasc Dis, 1994, 36(4): 309-342.
12. Nishimura RA, Carabello B. Operationalizing the 2014 ACC/AHA guidelines for valvular heart disease: A guide for clinicians. J Am Coll Cardiol, 2016, 67(19): 2289-2294.
13. Khan AA, Junejo RT, Thomas GN, et al. Heart rate variability in patients with atrial fibrillation and hypertension. Eur J Clin Invest, 2021, 51(1): e13361.
14. Little JG, Bealer SL. β adrenergic blockade prevents cardiac dysfunction following status epilepticus in rats. Epilepsy Res, 2012, 99(3): 233-239.
15. Mehta RH, Supiano MA, Grossman PM, et al. Changes in systemic sympathetic nervous system activity after mitral valve surgery and their relationship to changes in left ventricular size and systolic performance in patients with mitral regurgitation. Am Heart J, 2004, 147(4): 729-735.
16. Draghici AE, Taylor JA. The physiological basis and measurement of heart rate variability in humans. J Physiol Anthropol, 2016, 35(1): 22.
17. Brüler BC, Vieira TC, Wolf M, et al. Using the oculocardiac reflex to characterize autonomic imbalance in a naturally occurring canine model of valvular insufficiency. Comp Med, 2018, 68(2): 156-162.
18. 刘娟娟, 孙丹丹, 白洋, 等. 超声心动图评价肺动脉高压患者右房功能的研究进展. 临床超声医学杂志, 2019, 21(6): 443-445.
19. Linssen PBC, Veugen MGJ, Henry RMA, et al. Associations of (pre)diabetes with right ventricular and atrial structure and function: The Maastricht study. Cardiovasc Diabetol, 2020, 19(1): 88.
20. Khanji MY, Fung K, Donal E, et al. Impact of measurement variations in right atrial structure and function on outcomes. JACC Cardiovasc Imaging, 2019, 12(3): 569-570.
21. Jin Y, Wang H, Wang Z, et al. The evaluation of preoperative right ventricular diastolic dysfunction on coronary artery disease patients with left ventricular dysfunction. Echocardiography, 2014, 31(10): 1259-1264.
22. Liu C, Jiang XM, Zhang J, et al. Pulmonary artery denervation improves pulmonary arterial hypertension induced right ventricular dysfunction by modulating the local renin-angiotensin-aldosterone system. BMC Cardiovasc Disord, 2016, 16(1): 192.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Predictive value of systolic pulmonary artery pressure on autonomic nerve excitation in 186 patients with valvular disease: A prospective study

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content