The Diagnostic Value of Time Threshold Parameters of Heart Rate Variability in Holter Electrocardiogram for Autonomic Nervous Function Changes in Elderly Patients with Coronary Heart Disease Complicated with Hypertension
Objective To investigate the diagnostic value of threshold parameters in heart rate variability(HRV)in elderly patients with coronary heart disease(CHD)complicated with hypertension.Methods From January,2021 to June,2023,160 elderly patients with coronary heart disease were selected from the Department of General Medicine of Zhujing Community Health Service Center,Jinshan District,Shanghai.Holter electrocardiogram was performed in all patients,and the time threshold parameters of heart rate variability were collected.According to whether the autonomic nervous function changes occurred,they were divided into the autonomic nervous disorder group and the autonomic nervous normal group.Multivariate logistic regression analysis was used to identify the risk factors affecting autonomic nervous function changes in CHD patients with hypertension.Receiver operating characteristic(ROC)curve was drawn to evaluate the diagnostic value of threshold parameters in HRV for autonomic nervous function changes in elderly patients with CHD complicated with hypertension.Results The standard deviation of normal R-R interval(SDNN),the mean standard deviation of normal R-R interval every 5min(SDANN),and the stroke number ratio(PNN50)of adjacent R-R interval difference＞50ms in the autonomic nervous disorder group were lower than those in the normal autonomic nervous disorder group(P＜0.05).The smoking history and systolic blood pressure in the autonomic nervous disorder group were higher than those in the normal autonomic nervous system group(P＜0.05).Logistic regression analysis showed that systolic blood pressure,SDNN,SDANN and PNN50 were risk factors for autonomic nervous function changes in CHD patients with hypertension(P＜0.05).ROC analysis results showed:the AUC values(95％CI)of SDNN,SDANN and PNN50 were 0.704(0.627-0.774),0.673(0.595-0.745),0.715(0.595-0.745)and 0.862(0.798-0.91)respectively.The combined prediction efficiency of the three-marker test was higher than that of each single-marker test(Z=3.150,3.728,2.911,P＜0.05).Conclusion The threshold parameters of HRV in CHD patients were abnormal,and low levels of SDNN,SDANN and PNN50 were independent risk factors for CHD.The combination of the three markers has a high diagnostic value for the changes of autonomic nervous function in elderly patients with CHD and hypertension.
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