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首页> 外文期刊>Journal of the American College of Cardiology >Circadian variation in the effects of aldosterone blockade on heart rate variability and QT dispersion in congestive heart failure.
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Circadian variation in the effects of aldosterone blockade on heart rate variability and QT dispersion in congestive heart failure.

机译：充血性心力衰竭中醛固酮阻滞对心率变异性和QT离散度影响的昼夜变化。

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OBJECTIVES: The study was designed to comprehensively evaluate the circadian effects of aldosterone blockade on autonomic tone and QT dispersion in chronic heart failure (CHF). BACKGROUND: Spironolactone therapy given in addition to angiotensin-converting enzyme inhibitors improved survival in CHF, but the mechanism of its benefit is uncertain. Experimental evidence suggests that aldosterone may have detrimental effects on the autonomic nervous system, especially during the morning hours. METHODS: Twenty-eight patients with New York Heart Association class II to IV CHF received spironolactone 50 mg daily and placebo for four weeks each in a double-blind crossover fashion. After each treatment phase, a full circadian assessment was undertaken of spironolactone's autonomic effects. The assessment included monitoring heart rate, QT dispersion, continuous Holter recordings, heart rate variability (HRV) and norepinephrine kinetics. RESULTS: Spironolactone significantly reduced all indices of QT dispersion. The reductions in QTcmax, QTd and QTcd were greatest at 6 AM. In addition, spironolactone had favorable autonomic effects, which were limited to the morning (6-10 AM), including heart rate reduction and an improvement in HRV. CONCLUSIONS: Spironolactone reduced heart rate and improved HRV and QT dispersion in CHF. Its effects were particularly prominent during the morning hours.
机译：目的：本研究旨在全面评估醛固酮拮抗剂对慢性心力衰竭（CHF）患者自主神经张力和QT离散度的昼夜节律影响。背景：除了血管紧张素转换酶抑制剂外，还使用螺内酯治疗可改善CHF的生存率，但其获益机制尚不确定。实验证据表明，醛固酮可能会对植物神经系统产生有害影响，尤其是在早晨。方法：28名纽约心脏协会II至IV级CHF患者以双盲交叉方式接受每日50 mg螺内酯和安慰剂治疗，每组4周。在每个治疗阶段之后，对螺内酯的植物神经功能进行了完整的昼夜节律评估。评估包括监测心率，QT离散度，连续动态心电图记录，心率变异性（HRV）和去甲肾上腺素动力学。结果：螺内酯显着降低了所有QT分散指数。 QTcmax，QTd和QTcd的下降在上午6点最大。此外，螺内酯具有良好的自主神经作用，仅限于早晨（6-10 AM），包括降低心率和改善HRV。结论：螺内酯可降低心律，并改善CHF患者的HRV和QT离散度。在早晨，其效果尤为突出。

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