EFFECTS OF LEFT-VENTRICULAR DYSFUNCTION ON THE CIRCADIAN VARIATION OF VENTRICULAR PREMATURE COMPLEXES IN HEALED MYOCARDIAL-INFARCTION

被引:23
作者
GILLIS, AM
PETERS, RW
MITCHELL, LB
DUFF, HJ
MCDONALD, M
WYSE, DG
机构
[1] UNIV CALGARY, DEPT MED, DIV CARDIOL, 3330 HOSP DR NW, CALGARY T2N 4N1, ALBERTA, CANADA
[2] UNIV MARYLAND, DIV CARDIOL, BALTIMORE, MD 21201 USA
关键词
D O I
10.1016/0002-9149(92)90855-S
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Circadian variation in the onset of cardiovascular events including sudden cardiac death, myocardia infarction and ventricular arrhythmias has been described. The effect of left ventricular (LV) dysfunction on the circadian variation of ventricular premature complex (VPC) frequency was evaluated in 132 patients with frequent VPCs and reduced LV function after myocardial infarction. Patients were prospectively divided in 2 groups based on LV ejection fraction (EF) (those with LVEF less-than-or-equal-to 0.30, and those with LVEF between 0.30 and 0.45). Median hourly VPC frequencies and heart rates were compared between the 2 groups. Subgroup analyses based on treatment with beta-adrenoceptor blocking agents and on New York Heart Association functional class were also performed. In patients with LVEF > 0.30, a distinct circadian variation of VPCs, and the expected morning increase in VPC frequency were present. In contrast, a distinct circadian variation of VPCs was absent in patients with LVEF less-than-or-equal-to 0.30. A circadian variation of VPC frequency was also absent in patients with severe symptomatic congestive heart failure (New York Heart Association class III-IV). Treatment with beta-adrenoceptor blocking agents was associated with a loss of the circadian variation of VPC frequency. The circadian variation of heart rate was also blunted in the group treated with beta-adrenoceptor blocking agents. The proportion of subjects manifesting a positive correlation between heart rate and VPC frequency was lower in subjects with LVEF less-than-or-equal-to 0.30 (26%) than in those with LVEF > 0.30 (46%) (p < 0.05). Thus, circadian variation of VPC frequency is absent in patients with severe LV dysfunction.
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页码:1009 / 1014
页数:6
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