관상동맥질환에서 안정시 심박변동 및 최대운동 후 심박수 회복에 대한 베타차단제의 영향 = Effect of Beta Blocker on Heart Rate Variability at Rest and Heart Rate Recovery after Maximum Exercise for Coronary Artery Disease

국문 초록 (Abstract)

본 연구는 관상동맥질환 환자에서 안정시 심박변동 및 최대운동 후 심박수 회복을 통해 베타 차단제가 자율신경계에 미치는 영향을 알아 보고자 시행되었다. 연구의 대상자는 정상군 16명, 관상동맥질환 환자 중 베타차단제 비투여군 13명, 관상동맥질환 환자 중 베타차단제 투여군 9명의 세군으로 구분하여 안정시 심박변동 및 최대강도의 트레드밀 운동 후 5분간의 심박수 회복을 평가하였다. 심박변동은 시간영역 분석방법을 통한 RR간격의 표준편차(the standard deviation of the NN interval; SDNN), RMSSD(the root mean square successive differences)와 주파수영역 분석방법을 통한 저주파영역 전력(low frequency power; LF), 고주파영역 전력(high frequency power; HF), 저주파영역/고주파영역 비(LF/HF ratio)를 구하여 평가하였다. 심박수 회복은 최대심박수와 회복기 심박수의 차이로 최대운동 후 5분 동안 1분 간격으로 심박수를 측정하여 구하였다. 심박수 회복의 평가에서 개개인의 최대심박수 차이에 따른 영향을 극복하기위해 여유심박수 백분율[(회복기 심박수-안정시 심박수)/(측정된 최대심박수-안정시 심박수)×100]을 구하여 이용하였다. 결과는 다음과 같다. SDNN과 저주파영역 전력은 관상동맥질환 환자군에서 정상군보다 유의하게 낮았으나 베타 차단제 투여군과 비투여군 사이에는 심박변동의 모든 지표에서 유의한 차이가 없었다. 반면 최대강도운동 후 회복기에 매분마다의 심박수는 베타차단제 투여군이 정상군에 비하여 유의하게 낮았고, 심박수 회복은 정상군이 베타차단제 비투여군과 투여군에 비하여 유의하게 높았다. 회복기 여유심박수 백분율은 베타차단제 비투여군이 정상군에 비해 최대운동 후 회복기 1분, 2분, 3분대에서 유의하게 낮았으며, 정상군과 베타차단제 투여군 사이에는 유의한 차이가 없었다. 이상의 결과로 관상동맥질환 환자는 정상인에 비하여 교감신경 활동도는 증가되어 있고, 부교감신경 활동도는 감소되어 있는 것을 알 수 있었으며, 베타 차단제는 자율신경계를 정상화시켜 관상동맥질환 환자의 심박수 회복율을 증가시키는 것으로 생각한다.

다국어 초록 (Multilingual Abstract)

The purpose of this study was to evaluate the effect of beta blocker on autonomic nervous activity with using heart rate recovery(HRR) after maximum exercise and heart rate variability(HRV) at rest for coronary artery disease(CAD) patients. The 38 subjects were divided into three groups. The control group consisted of 16 normal subjects. The non beta blocker group consisted of 13 CAD patients who didn`t take beta blocker. The beta blocker group consisted of 9 CAD patients who took beta blocker. Time domain and frequency domain of HRV were measured in three groups at rest. The time domain consisted of the standard deviation of the NN interval(SDNN) and the root mean square successive differences(RMSSD). The frequency domain consisted of low frequency power(LF), high frequency power(HF), and LF/HF ratio. Heart rate, HRR(maximum heart rate-heart rate at recovery stage), the percent of heart rate reserve{(heart rate at recovery stage-resting heart rate)/(measured maximum heart rate-resting heart rate)×100} were evaluated during five minutes after maximum exercise. The criteria for maximum exercise were a respiratory exchange ratio of 1.1 or 90% of the age determined maximum heart rate. The SDNN and LF were significantly lower in both beta and non beta blocker groups than in control group. However, there was no significant difference between beta blocker group and non beta blocker group. Heart rate during five minutes after maximum exercise was significantly lower in beta blocker group than in control. HRR from the maximal heart rate during five minutes after exercise was significantly higher in control group than in beta blocker and non beta blocker groups. The percent of heart rate reserve in control group was significantly lower than non beta blocker group at 1, 2 and 3 minutes after exercise. There was no significant difference between beta blocker group and control group for the percent of heart rate reserve. This study demonstrated reduced control of the autonomic nervous activity and delayed heart rate recovery in CAD patients. HRR in CAD patients was normalized by beta blocker. Beta blocker improve balance of autonomic nervous activity in CAD patients.

참고문헌 (Reference)

1 "심박변동의 Power Spectrum 분석에 의한 정상 성인의 자율신경기능 평가" 928-935, 1997

2 "the impact of coronary heart disease on patients' daily activities" 1642-1647, 1985

3 "standards of measurement Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology" 1043-1065, 1996

4 "Vagally mediated heart rate recovery after exercise is accelerated in athletes but blunted in patients with chronic heart failure" 1529-1535, 1994

5 "The role of beta adrenergic blocking agents in preventing sudden cardiac death" 1-, 1992

6 "Spinal sympathetic reflexes initiated by coronary receptors" 685-705, 1971

7 "Prognostic role of heart rate variability in patients with a recent acute myocardial infarction" 1323-1328, 1998

8 "Modulation of cardiac autonomic activity during and immediately after exercise" 1989

9 "Insights from the study of heart rate variability" 249-261, 1999

10 "Heart rate variability in patients with acute myocardial infarction undergoing primary coronary angioplasty" 815-820, 2000

11 "Heart rate variability during the acute phase of myocardial infarction" sig (sig): 2073-2079, 1992

12 "Heart rate variability assessment early after acute myocardial infarction Global utilization of streptokinase and TPA for occluded arteries" 1388-1395, 1996

13 "Heart rate recovery immediately after exercise as a predictor of mortality" 1351-1357, 1999

14 "Heart rate recovery and treadmill exercise score as predictors of mortality in patients referred for exercise ECG" 1392-1398, 2000

15 "Heart rate recovery after treadmill exercise testing and risk of cardiovascular disease events" 848-852, 2002

16 "Heart rate recovery after submaximal exercise testing as a predictor of mortality in a cardiovascular health cohort" 552-555, 2000

17 "Frequency domain measures of heart period variability and mortality after myocardial infarction" 164-171, 1992

18 "Exercise training confers anticipatory protection from sudden death during acute myocardial ischemia" 548-552, 1994

19 "Exercise in secondary prevention and cardiac rehabilitation exercise and autonomic function in health and cardiovascular disease" 369-387, 2001

20 "Effects of propranolol on recovery of heart rate variability following acute myocardial infarction and relation to outcome in the beta-blocker heart attack trial" 137-142, 2003

21 "Effects of cardiac rehabilitation and exercise training on autonomic regulation in patients with coronary artery disease" 977-983, 2002

22 "Effects of cardiac rehabilitation and beta-blocker therapy on heart rate variability after first acute myocardial infarction" 834-840, 1998

23 "Effects of beta blockers atenolol or metoprolol on heart rate variability after acute myocardial infarction" 340-345, 1994

24 "Effects of a single bout of exercise on resting heart rate variability" 1140-1148, 2004

25 "Effect of exercise training on heart rate variability in patients with new onset left ventricular dysfunction after myocardial infarction" 157-161, 2000

26 "Effect of exercise training in patients with heart failure a pilot study on autonomic balance assessed by heart rate variability" Aarsland 162-167, 2004

27 "Comparison of 24 hour parasympathetic activity in endurance-trained and untrained young men" 552-558, 1992

28 "Cardiac rehabilitation and secondary prevention of coronary heart disease" 892-902, 2001

29 "Cardiac autonomic regulation after moderate and exhaustive exercises" 333-338, 1992

30 "Beta blockade during and after myocardial infarction an overview of the randomized trials" 335-371, 1985

31 "Autonomic control of heart rate: pharmacological and nonpharma- cological modulation" 93 133-1 142, 1998

32 "Autonomic control of heart rate during exercise studied by heart rate variability spectral analysis" 1136-1142, 1991

33 "ACSM's resource manual for guidelines for exercise and pre- scription" Williams & Wilkins. 1998