.: ORİJİNAL ARAŞTIRMA
Heart Rate Turbulence Analysis in Healthy Postmenopausal Women
Sağlıklı Postmenopozal Kadınlarda Kalp Hızı Türbülansı Analizi
Turkiye Klinikleri J Cardiovasc Sci. 2021;33(1):1-6
doi: 10.5336/cardiosci.2020-77696
Makale Dili: EN
Tam Metin
ABSTRACT
Objective: The aim of the present study was to investigate heart rate turbulence (HRT) parameters in postmenopausal women. Material and Methods: A total of 40 postmenopausal women and 43 healthy, regularly menstruating premenopausal women were taken as study and control groups, respectively. All patients had biochemical blood examination, 2-D echocardiography and 24-hour Holter monitorization. HRT parameters, namely turbulence onset (TO) and turbulence slope (TS) were calculated. Results: Age, body mass index (BMI), systolic and diastolic pressure, total cholesterol and LDL levels were higher in the postmenopausal group, whereas HDL levels were higher in the premenopausal group (p<0.05). TO was significantly higher, TS was significantly lower in postmenopausal women compared to premenopausal women (-2.76±1.34 vs 0.60±1.30 and 3.60±1.54 vs 1.60±1.48, p=0.000 for both, respectively). TO was positively correlated, TS negatively correlated with age, BMI, systolic and diastolic blood pressure and LDL cholesterol level. According to multivariate analysis only menopausal status and age had an independent effect on HRT parameters. Receiver operating characteristic analysis showed that the cut-off values of TO and TS for predicting menopausal status were 0.959 and 0.165, respectively (0.835 anti-image). These results showed that TO and TS had diagnostic value for predicting menopausal status. Conclusion: Postmenopausal women had blunted HRT response. It is a simple and easily obtainable test and should be implemented in cardiac evaluation in daily practice.
Keywords: Postmenopause; women; heart rate
Objective: The aim of the present study was to investigate heart rate turbulence (HRT) parameters in postmenopausal women. Material and Methods: A total of 40 postmenopausal women and 43 healthy, regularly menstruating premenopausal women were taken as study and control groups, respectively. All patients had biochemical blood examination, 2-D echocardiography and 24-hour Holter monitorization. HRT parameters, namely turbulence onset (TO) and turbulence slope (TS) were calculated. Results: Age, body mass index (BMI), systolic and diastolic pressure, total cholesterol and LDL levels were higher in the postmenopausal group, whereas HDL levels were higher in the premenopausal group (p<0.05). TO was significantly higher, TS was significantly lower in postmenopausal women compared to premenopausal women (-2.76±1.34 vs 0.60±1.30 and 3.60±1.54 vs 1.60±1.48, p=0.000 for both, respectively). TO was positively correlated, TS negatively correlated with age, BMI, systolic and diastolic blood pressure and LDL cholesterol level. According to multivariate analysis only menopausal status and age had an independent effect on HRT parameters. Receiver operating characteristic analysis showed that the cut-off values of TO and TS for predicting menopausal status were 0.959 and 0.165, respectively (0.835 anti-image). These results showed that TO and TS had diagnostic value for predicting menopausal status. Conclusion: Postmenopausal women had blunted HRT response. It is a simple and easily obtainable test and should be implemented in cardiac evaluation in daily practice.
Keywords: Postmenopause; women; heart rate
ÖZET
Amaç: Bu çalışma, sağlıklı postmenopozal kadınlarda kalp hızı türbülansı (KHT) analizini incelemek için yapıldı. Gereç ve Yöntemler: Çalışmaya, 40 sağlıklı postmenopozal kadın ve 43 düzenli adet gören premenopozal kadın alınmıştır. Tüm bireylere biyokimyasal kan testleri, 2 boyutlu ekokardiyografi ve 24 saatlik Holter monitörizasyonu yapıldı. KHT parametreleri olan türbülans başlangıcı (TB) ve türbülans eğimi (TE) hesaplandı. Bulgular: Postmenopozal grupta yaş, beden kitle indeksi (BKİ), sistolik ve diyastolik kan basıncı, total ve LDL kolesterol seviyeleri daha yüksek iken, HDL seviyesi daha düşük bulundu (p<0,05). Premenopozal kadınlar ile karşılaştırıldığında, postmenopozal kadınların TB değeri belirgin olarak yüksek, TE değeri ise belirgin olarak düşük idi (sırasıyla -2,76±1,34; 0,60±1,30 ve 3,60±1,54; 1,60±1,48, her ikisi için p=0,000). Yaş, BKİ, sistolik ve diyastolik kan basıncı, LDL düzeyi TB ile pozitif, TE ile negatif korelasyon gösterdi. Multivaryant analizine göre sadece menopoz durumu ve yaş, KHT parametreleri üzerinde bağımsız bir etki gösterdi. Alıcı işlem karakteristikleri analizine göre TB ve TE'nin menopozal durumu prediktif değeri sırasıyla 0,959 ve 0,165 idi (0,835 anti-imaj). Bu bulgular TB ve TE'nin menopoz durumunu öngörmede tanısal değeri olduğunu göstermiştir. Sonuç: Postmenopozal kadınlarda, KHT cevabı bozulmuştur. Bu test klinikte oldukça kolay olarak uygulanılabilen basit bir testtir ve postmenopozal kadınların kardiyak değerlendirilmesinde düşünülmelidir.
Anahtar Kelimeler: Postmenapoz; kadınlar; kalp hızı
Amaç: Bu çalışma, sağlıklı postmenopozal kadınlarda kalp hızı türbülansı (KHT) analizini incelemek için yapıldı. Gereç ve Yöntemler: Çalışmaya, 40 sağlıklı postmenopozal kadın ve 43 düzenli adet gören premenopozal kadın alınmıştır. Tüm bireylere biyokimyasal kan testleri, 2 boyutlu ekokardiyografi ve 24 saatlik Holter monitörizasyonu yapıldı. KHT parametreleri olan türbülans başlangıcı (TB) ve türbülans eğimi (TE) hesaplandı. Bulgular: Postmenopozal grupta yaş, beden kitle indeksi (BKİ), sistolik ve diyastolik kan basıncı, total ve LDL kolesterol seviyeleri daha yüksek iken, HDL seviyesi daha düşük bulundu (p<0,05). Premenopozal kadınlar ile karşılaştırıldığında, postmenopozal kadınların TB değeri belirgin olarak yüksek, TE değeri ise belirgin olarak düşük idi (sırasıyla -2,76±1,34; 0,60±1,30 ve 3,60±1,54; 1,60±1,48, her ikisi için p=0,000). Yaş, BKİ, sistolik ve diyastolik kan basıncı, LDL düzeyi TB ile pozitif, TE ile negatif korelasyon gösterdi. Multivaryant analizine göre sadece menopoz durumu ve yaş, KHT parametreleri üzerinde bağımsız bir etki gösterdi. Alıcı işlem karakteristikleri analizine göre TB ve TE'nin menopozal durumu prediktif değeri sırasıyla 0,959 ve 0,165 idi (0,835 anti-imaj). Bu bulgular TB ve TE'nin menopoz durumunu öngörmede tanısal değeri olduğunu göstermiştir. Sonuç: Postmenopozal kadınlarda, KHT cevabı bozulmuştur. Bu test klinikte oldukça kolay olarak uygulanılabilen basit bir testtir ve postmenopozal kadınların kardiyak değerlendirilmesinde düşünülmelidir.
Anahtar Kelimeler: Postmenapoz; kadınlar; kalp hızı
REFERANSLAR:
- Atsma F, Bartelink ML, Grobbee DE, van der Schouw YT. Postmenopausal status and early menopause as independent risk factors for cardiovascular disease: a meta-analysis. Menopause. 2006;13(2):265-79.[Crossref] [PubMed]
- Lerner UH. Bone remodeling in post-menopausal osteoporosis. J Dent Res. 2006;85(7):584-95.[Crossref] [PubMed]
- Dart AM, Du XJ, Kingwell BA. Gender, sex hormones and autonomic nervous control of the cardiovascular system. Cardiovasc Res. 2002;53(3):678-87.[Crossref] [PubMed]
- Ribeiro TF, Azevedo GD, Crescêncio JC, Marães VR, Papa V, Catai AM, et al. Heart rate variability under resting conditions in postmenopausal and young women. Braz J Med Biol Res. 2001;34(7):871-7.[Crossref] [PubMed]
- Neves VF, Silva de Sá MF, Gallo L Jr, Catai AM, Martins LE, Crescêncio JC, et al. Autonomic modulation of heart rate of young and postmenopausal women undergoing estrogen therapy. Braz J Med Biol Res. 2007;40(4):491-9.[Crossref] [PubMed]
- Lee JO, Kang SG, Kim SH, Park SJ, Song SW. The relationship between menopausal symptoms and heart rate variability in middle aged women. Korean J Fam Med. 2011;32(5):299-305.[Crossref] [PubMed] [PMC]
- Schmidt G, Malik M, Barthel P, Schneider R, Ulm K, Rolnitzky L, et al. Heart-rate turbulence after ventricular premature beats as a predictor of mortality after acute myocardial infarction. Lancet. 1999;353(9162):1390-6.[Crossref] [PubMed]
- Disertori M, Masè M, Rigoni M, Nollo G, Ravelli F. Heart rate turbulence is a powerful predictor of cardiac death and ventricular arrhythmias in postmyocardial infarction and heart failure patients: a systematic review and meta-analysis. Circ Arrhythm Electrophysiol. 2016;9(12):e004610.[Crossref] [PubMed]
- Mitchell C, Rahko PS, Blauwet LA, Canaday B, Finstuen JA, Foster MC, et al. Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2019;32(1):1-64.[Crossref] [PubMed]
- Kretzschmar J, Babbitt DM, Diaz KM, Feairheller DL, Sturgeon KM, Perkins AM, et al. A standardized exercise intervention differentially affects premenopausal and postmenopausal African-American women. Menopause. 2014;21(6):579-84.[Crossref] [PubMed] [PMC]
- Newson L. Menopause and cardiovascular disease. Post Reprod Health. 2018;24(1):44-9.[Crossref] [PubMed]
- Saha KR, Rahman MM, Paul AR, Das S, Haque S, Jafrin W, et al. Changes in lipid profile of postmenopausal women. Mymensingh Med J. 2013;22(4):706-11.[PubMed]
- Coylewright M, Reckelhoff JF, Ouyang P. Menopause and hypertension: an age-old debate. Hypertension. 2008;51(4):952-9.[Crossref] [PubMed]
- Moodithaya SS, Avadhany ST. Comparison of cardiac autonomic activity between pre and post menopausal women using heart rate variability. Indian J Physiol Pharmacol. 2009;53(3):227-34.[PubMed]
- Lombardi F, Stein PK. Origin of heart rate variability and turbulence: an appraisal of autonomic modulation of cardiovascular function. Front Physiol. 2011;2:95.[Crossref] [PubMed] [PMC]
- Lin LY, Lai LP, Lin JL, Du CC, Shau WY, Chan HL, et al. Tight mechanism correlation between heart rate turbulence and baroreflex sensitivity: sequential autonomic blockade analysis. J Cardiovasc Electrophysiol. 2002;13(5):427-31.[Crossref] [PubMed]
- Watanabe MA, Schmidt G. Heart rate turbulence: a 5-year review. Heart Rhythm. 2004;1(6):732-8.[Crossref] [PubMed]
- Barthel P, Schneider R, Bauer A, Ulm K, Schmitt C, Schömig A, et al. Risk stratification after acute myocardial infarction by heart rate turbulence. Circulation. 2003;108(10):1221-6.[Crossref] [PubMed]
- Koyama J, Watanabe J, Yamada A, Koseki Y, Konno Y, Toda S, et al. Evaluation of heart-rate turbulence as a new prognostic marker in patients with chronic heart failure. Circ J. 2002;66(10):902-7.[Crossref] [PubMed]
- Erdem A, Uenishi M, Küçükdurmaz Z, Matsumoto K, Kato R, Hara M, et al. The effect of metabolic syndrome on heart rate turbulence in non-diabetic patients. Cardiol J. 2012;19(5):507-12.[Crossref] [PubMed]
- Ortak J, Weitz G, Wiegand UK, Bode F, Eberhardt F, Katus HA, et al. Changes in heart rate, heart rate variability, and heart rate turbulence during evolving reperfused myocardial infarction. Pacing Clin Electrophysiol. 2005;28 Suppl 1:S227-32.[Crossref] [PubMed]
- Bonnemeier H, Richardt G, Potratz J, Wiegand UK, Brandes A, Kluge N, et al. Circadian profile of cardiac autonomic nervous modulation in healthy subjects: differing effects of aging and gender on heart rate variability. J Cardiovasc Electrophysiol. 2003;14(8):791-9.[Crossref] [PubMed]
- Melenovsky V, Wichterle D, Simek J, Malik J, Haas T, Ceska R, et al. Effect of atorvastatin and fenofibrate on autonomic tone in subjects with combined hyperlipidemia. Am J Cardiol. 2003;92(3):337-41.[Crossref] [PubMed]
- Schwartz PJ, Zipes DP. Autonomic modulation of cardiac arrhythmias. In: Zipes DP, Jalife J, eds. Cardiac Electrophysiology: From Cell to Bedside. 2nd ed. Philadelphia: WB Saunders; 1995. p.300-14.
- Sarikaya S, Sahin S, Akyol L, Altunkas F, Karaman K. Assessement of autonomic function with heart rate turbulence and heart rate variability in young obese patients. Int J Med Sci Public Health. 2014;3(9):1110-4.[Crossref]
- Christensen JH, Toft E, Christensen MS, Schmidt EB. Heart rate variability and plasma lipids in men with and without ischaemic heart disease. Atherosclerosis. 1999;145(1):181-6.[Crossref] [PubMed]
- Melenovsky V, Wichterle D, Simek J, Malik J, Haas T, Ceska R, et al. Effect of atorvastatin and fenofibrate on autonomic tone in subjects with combined hyperlipidemia. Am J Cardiol. 2003;92(3):337-41.[Crossref] [PubMed]
- Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, et al; European Association for Cardiovascular Prevention & Rehabilitation (EACPR); ESC Committee for Practice Guidelines (CPG). European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J. 2012;33(13):1635-701. Erratum in: Eur Heart J. 2012;33(17):2126.[PubMed]
.: İşlem Listesi