Evaluation value of 24-hour dynamic electrocardiogram for heart rate variability in children with myocarditis of different ages
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目的 研究24 h动态心电图对不同年龄段儿童心肌炎心率变异性的评估价值。 方法 回顾性队列研究。抽取2021年3月至2022年9月郑州大学附属儿童医院收治的116例心肌炎患儿作为研究组，按照患儿年龄段分为低年龄(年龄<4岁)组47例和高年龄(年龄≥4岁)组69例，并以1∶1配比抽取同期健康体检儿童116例作为对照组，按照儿童年龄分为低年龄(年龄<4岁)对照组52例和高年龄(年龄≥4岁)对照组64例。均行24 h动态心电图检查，比较各组儿童心率和心率变异性指标[正常窦性心律RR间期的标准差(SDNN)、每5 min RR间期标准差(sDANN)、相邻RR间期差值>50 ms的心搏个数占RR间期总数的百分比(PNN50)、24 h全程相邻RR间期差值的均方根(rMSSD)]水平。 结果 低年龄组最慢心率、平均心率[(67.59±6.85)、(110.86±12.05)次/min]均高于低年龄对照组[(60.03±6.02)、(99.31±9.76)次/min]，P均<0.05；高年龄组最慢心率、平均心率[(59.86±4.02)、(97.85±10.53)次/min]均高于高年龄对照组[(54.03±3.21)、(91.05±8.92)次/min]，P均<0.05。低年龄组SDNN、sDANN、PNN50、rMSSD水平低于低年龄对照组(P<0.05)；高年龄组SDNN、PNN50、rMSSD水平低于高年龄对照组(P<0.05)。低年龄组最快心率、最慢心率、平均心率均高于高年龄组(P均<0.05)；低年龄组SDNN、sDANN、PNN50、rMSSD水平均低于高年龄组(P均<0.05)。 结论 心肌炎患儿的24 h动态心电图心率较高，且心率变异性指标水平较低，不同年龄段心肌炎患儿心率和心率变异性指标水平存在明显差异性，年龄越低，患儿心率越高，心率变异性指标水平越低。 Objective To investigate the value of 24-hour dynamic electrocardiogram in evaluating heart rate variability in children with myocarditis of different ages. Methods In this retrospective cohort study, 116 children with myocarditis treated in Children’s Hospital Affiliated of Zhengzhou University from March 2021 to September 2022 were selected as the study group, and they were further divided into a low-age group (age < 4 years, 47 cases) and a high-age group (age ≥4 years, 69 cases) according to the age of the children. A total of 116 children who underwent physical examination in the same period were selected as the control group with a ratio of 1∶1. According to the age of the children, children in the control group were divided into a low-age control group (age < 4 years, 52 cases) and a high-age control group (age ≥4 years, 64 cases). The 24-hour dynamic electrocardiogram examination was performed on all selected children. The heart rate and heart rate variability indexes, including standard diviation of all normal-to-normal intervals (SDNN), standard diviation of 5-min average normal-to-normal intervals (sDANN), percentage of intervals, >50 ms different from preceding interval (PNN50) and the 24-hour root mean square of successive differences in adjacent normal-to-normal intervals (rMSSD) were compared among each group. Results The minimum heart rate and average heart rate in the low-age group were 67.59±6.85 and (110.86±12.05) times/min, higher than the 60.03±6.02 and (99.31±9.76) times/min in the low-age control group (all P<0.05). The minimum heart rate and average heart rate in the high-age group were 59.86±4.02 and (97.85±10.53) times/min, higher than the 54.03±3.21 and (91.05±8.92) times/min in the high-age control group (allP<0.05). The levels of SDNN, sDANN, PNN50 and rMSSD in the low-age group were lower than those in the low-age control group (P<0.05). The levels of SDNN, PNN50 and rMSSD in the high-age group were lower than those in the high-age control group (P<0.05). The maximum heart rate, minimum heart rate and average heart rate in the low-age group were higher than those in the high-age group (allP<0.05). The levels of SDNN, sDANN, PNN50 and rMSSD in the low-age group were lower than those in the high-age group (allP<0.05). Conclusions Children with myocarditis have higher heart rates and lower levels of heart rate variability indicators showed by 24-hour dynamic electrocardiogram. There are obvious differences in the level of heart rate and heart rate variability among children with myocarditis in different age groups. The heart rate variability in children with myocarditis is lower in children with younger age and higher heart rate.
Objective To investigate the value of 24-hour dynamic electrocardiogram in evaluating heart rate variability in children with myocarditis of different ages. Methods In this retrospective cohort study, 116 children with myocarditis treated in Children’s Hospital Affiliated of Zhengzhou University from March 2021 to September 2022 were selected as the study group, and they were further divided into a low-age group (age < 4 years, 47 cases) and a high-age group (age ≥4 years, 69 cases) according to the age of the children. A total of 116 children who underwent physical examination in the same period were selected as the control group with a ratio of 1∶1. According to the age of the children, children in the control group were divided into a low-age control group (age < 4 years, 52 cases) and a high-age control group (age ≥4 years, 64 cases). The 24-hour dynamic electrocardiogram examination was performed on all selected children. The heart rate and heart rate variability indexes, including standard diviation of all normal-to-normal intervals (SDNN), standard diviation of 5-min average normal-to-normal intervals (sDANN), percentage of intervals, >50 ms different from preceding interval (PNN50) and the 24-hour root mean square of successive differences in adjacent normal-to-normal intervals (rMSSD) were compared among each group. Results The minimum heart rate and average heart rate in the low-age group were 67.59±6.85 and (110.86±12.05) times/min, higher than the 60.03±6.02 and (99.31±9.76) times/min in the low-age control group (all P<0.05). The minimum heart rate and average heart rate in the high-age group were 59.86±4.02 and (97.85±10.53) times/min, higher than the 54.03±3.21 and (91.05±8.92) times/min in the high-age control group (allP<0.05). The levels of SDNN, sDANN, PNN50 and rMSSD in the low-age group were lower than those in the low-age control group (P<0.05). The levels of SDNN, PNN50 and rMSSD in the high-age group were lower than those in the high-age control group (P<0.05). The maximum heart rate, minimum heart rate and average heart rate in the low-age group were higher than those in the high-age group (allP<0.05). The levels of SDNN, sDANN, PNN50 and rMSSD in the low-age group were lower than those in the high-age group (allP<0.05). Conclusions Children with myocarditis have higher heart rates and lower levels of heart rate variability indicators showed by 24-hour dynamic electrocardiogram. There are obvious differences in the level of heart rate and heart rate variability among children with myocarditis in different age groups. The heart rate variability in children with myocarditis is lower in children with younger age and higher heart rate.
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