Clinical Study on the Diagnostic Value of Circadian Variability of Systolic Blood Pressure Combined with SDNN in Coronary Heart Disease

doi:10.12114/j.issn.1007-9572.2023.0622

Abstract

Abstract:

Background

At present, the main methods for diagnosing coronary heart disease are coronary contrast-enhanced computed tomography and angiography, of which coronary contrast-enhanced computed tomography is limited in clinical application due to its poor accuracy and some patients inability to perform because of rapid heart rate. While coronary angiography, which is the "gold standard", is also hampered in its promotion due to its invasive nature and the difficulty in popularizing in primary care institutions. It is particularly important to use some simple and easily accessible indicators to participate in the diagnosis of coronary heart disease. This study explores the diagnostic value of circadian variability of systolic blood pressure combined with standard deviation of NN intervals (SDNN) in coronary heart disease, with the aim of proposing a simple and practical new predictive method.

Objective

To explore the diagnostic and predictive value of circadian variability of systolic blood pressure combined with SDNN for coronary heart disease, in order to provide non-invasive methodological reference for evaluating and predicting the diagnosis of coronary heart disease.

Methods

From 2018 to 2022, 246 patients who were definitely diagnosed as coronary heart disease by coronary angiography and had Holter monitor examination results and blood pressure monitoring records before coronary angiography were selected as the research objects, and the general baseline data of coronary heart disease and non coronary heart disease were compared. Using the diagnosis of coronary heart disease as the observation endpoint, the correlation between various parameters included in the observation and endpoint events was analyzed, as well as the possible influencing factors related to endpoint events. The predictive value of circadian variability of systolic blood pressure combined with SDNN for the diagnosis of disease was further analyzed.

Results

The baseline data comparison between the coronary heart disease group and non coronary heart disease group showed statistically significant differences in age, SDNN, and circadian variability of systolic blood pressure (P<0.05). Correlation analysis showed that age and circadian variability of systolic blood pressure were positively correlated with the diagnosis of coronary heart disease (P<0.05), left ventricular diastolic dimension (LVD) and SDNN were negatively correlated with the diagnosis of coronary heart disease (P<0.05). Binary Logistic regression analysis showed that age, LVD, end-diastolic volume (EDV), cardiac output (CO), SDNN, and circadian variability of systolic blood pressure were influential factors in the diagnosis of coronary heart disease (P<0.05). The AUC of SDNN for diagnosing coronary heart disease was 0.690 (95%CI=0.620-0.760), with sensitivity and specificity of 0.753 and 0.615, the corresponding optimal cutoff value was 128.5. The AUC of circadian variability of systolic blood pressure for diagnosing coronary heart disease was 0.908 (95%CI=0.869-0.948), with sensitivity and specificity of 0.847 and 0.896, and the corresponding optimal cutoff value was 14.61%. The AUC of circadian variability of systolic blood pressure combined with SDNN for diagnosing coronary heart disease was 0.914 (95%CI=0.875-0.953), with sensitivity and specificity of 0.827 and 0.917, and the corresponding optimal cutoff value was 0.721.

Conclusion

Age, LVD, EDV, CO, SDNN, and the diurnal variation rate of systolic blood pressure are influencing factors for the diagnosis of coronary heart disease. Circadian variability of systolic blood pressure combined with SDNN has good clinical application value in predicting and diagnosing coronary heart disease.

Key words: Circadian variability of systolic blood pressure, Standard deviation of normal to normal, Coronary disease, Diagnostic value

摘要：

背景

目前确诊冠心病的主要方法为冠状动脉增强CT及冠状动脉造影检查，其中冠状动脉增强CT检查由于准确性欠佳，部分患者心率过快不能进行导致其临床应用受限，而作为"金标准"的冠状动脉造影检查由于有创性，在基层医疗单位难以大范围普及同样使其推广受阻。

目的

探索收缩压昼夜变异率联合SDNN对冠心病的诊断价值，以期为评估冠心病诊断提供无创方法学参考。

方法

选取2018—2022年就诊于九江市第一人民医院的246例通过冠状动脉造影检查明确诊断为冠心病且在行冠状动脉造影检查前具有动态心电图检查结果以及病房内昼夜血压监测记录的患者作为研究对象，分为冠心病组与非冠心病组，比较两组对象的一般基线资料；将冠心病诊断与否作为观察终点，分析纳入观察的各项参数与终点事件的相关性并探索可能与终点事件相关的影响因素；绘制收缩压昼夜变异率联合正常窦性心搏间期标准差（SDNN）诊断冠心病的ROC曲线，并进行分析。

结果

冠心病组与非冠心病组基线资料的比较结果显示，年龄、SDNN、收缩压昼夜变异率之间的差异有统计学意义（P<0.05）。相关性分析结果显示，年龄和收缩压昼夜变异率与冠心病诊断呈正相关（P<0.05），左心室舒张末期内径（LVD）和SDNN与冠心病诊断呈负相关（P<0.05）。二元Logistic回归分析显示，年龄、LVD、左心室舒张末容积（EDV）、每分输出量（CO）、SDNN、收缩压昼夜变异率是冠心病诊断的影响因素（P<0.05）。SDNN诊断冠心病的AUC为0.690（95%CI=0.620~0.760），灵敏度和特异度分别为0.753和0.615，对应的最佳截断值为128.5。收缩压昼夜变异率诊断冠心病的AUC为0.908（95%CI=0.869~0.948），灵敏度和特异度分别为0.847和0.896，对应的最佳截断值为14.61%。收缩压昼夜变异率联合SDNN诊断冠心病的AUC为0.914（95%CI=0.875~0.953），灵敏度和特异度分别为0.827和0.917，对应的最佳截断值为0.721。

结论

年龄、LVD、EDV、CO、SDNN、收缩压昼夜变异率是冠心病诊断的影响因素。收缩压昼夜变异率联合SDNN对于冠心病的诊断具有较好的临床应用价值。

关键词: 收缩压昼夜变异率, RR间期标准差, 冠心病, 诊断价值

CLC Number:

R 544

ZHOU Qibao,LUO Xiao,CHEN Ling, et al. Clinical Study on the Diagnostic Value of Circadian Variability of Systolic Blood Pressure Combined with SDNN in Coronary Heart Disease[J]. Chinese General Practice, 2025, 28(30): 3760-3765. DOI: 10.12114/j.issn.1007-9572.2023.0622.
周启保,罗潇,陈玲等. 收缩压昼夜变异率联合正常RR间期标准差对冠心病诊断价值的临床研究[J]. 中国全科医学, 2025, 28(30): 3760-3765. DOI: 10.12114/j.issn.1007-9572.2023.0622.

Figures/Tables 3

References 30

[1]	KABOOTARI M, TAMEHRI ZADEH S S, HASHEMINIA M，et al. Change in blood pressure status defined by 2017 ACC/AHA hypertension guideline and risk of cardiovascular disease：results of over a decade of follow-up of the Iranian population[J]. Front Cardiovasc Med，2023,10:1044638. DOI：10.3389/fcvm.2023.1044638.
[2]	中国高血压防治指南修订委员会，高血压联盟，中华医学会心血管病学分会中国医师协会高血压专业委员会，等. 中国高血压防治指南（2018年修订版）[J]. 中国心血管杂志，2019,24(1):24-56. DOI：10.3969/j.issn.1007-5410.2019.01.002.
[3]	BROCKMANN L, HUNT K J. Heart rate variability changes with respect to time and exercise intensity during heart-rate-controlled steady-state treadmill running[J]. Sci Rep，2023,13:8515. DOI：10.1038/s41598-023-35717-0.
[4]	崔金秋，罗潇，陈玲，等. 血小板分布宽度联合正常RR间期标准差对心房颤动患者血压测量波动性的预测价值[J]. 吉林医学，2023,44(3):603-608. DOI：10.3969/j.issn.1004-0412.2023.03.009.
[5]	中华医学会，中华医学会杂志社，中华医学会全科医学分会，等.稳定性冠心病基层诊疗指南（2020年）[J].中华全科医师杂志，2021,3:265-273.
[6]	BRIDGES J, SHISHAVAN H H, SALMON A，et al. Exploring the potential of pulse transit time as a biomarker for sleep efficiency through a comparison analysis with heart rate and heart rate variability[J]. Sensors（Basel），2023,23(11):5112. DOI：10.3390/s23115112.
[7]	XU R Z, LI J J, LI G H，et al. SDNN：Symmetric deep neural networks with lateral connections for recommender systems[J]. Inf Sci Int J，2022,595(C):217-230. DOI：10.1016/j.ins.2022.02.050.
[8]	GIST K M, MENON S. Adherence to hypertension guidelines in children—what is all the hype?[J]. JAMA Netw Open，2023,6(4):e237002. DOI：10.1001/jamanetworkopen.2023.7002.
[9]	VILLAGRASA-FLORES A A, VEGA-COLÓN J D, CINTRÓN-ROSA F，et al. The effect of visit-to-visit blood pressure variability on renal function in geriatric chronic kidney disease[J]. P R Health Sci J，2023,42(2):127-131.
[10]	苏海，李雪，汤松涛. 家庭血压监测和动态血压监测应用中值得思考的问题[J]. 中华高血压杂志，2022,30(6):501-502. DOI：10.16439/j.issn.1673-7245.2022.06.001.
[11]	ROTKOPF L T, FROELICH M F, RIFFEL P，et al. Influence of heart rate and heart rate variability on the feasibility of ultra-fast，high-pitch coronary photon-counting computed tomography angiography[J]. Int J Cardiovasc Imaging，2023,39(5):1065-1073. DOI：10.1007/s10554-023-02808-y.
[12]	KIRSCH M, VITIELLO D, TRASCHEL L D，et al. Cardiac hemodynamics and individual responses to exercise training in patients with coronary heart disease[J]. Arch Cardiovasc Dis Suppl，2023,15(2):188-189. DOI：10.1016/j.acvdsp.2023.03.023.
[13]	HU J J, BONNICHSEN C R, DEARANI J A，et al. Adults with tetralogy of fallot: early postoperative outcomes and risk factors for complications[J]. Mayo Clin Proc，2021,96(9):2398-2406. DOI：10.1016/j.mayocp.2021.01.032.
[14]	DUDAREV V, BARRAL O, ZHANG C X，et al. On the reliability of wearable technology：a tutorial on measuring heart rate and heart rate variability in the wild[J]. Sensors（Basel），2023,23(13):5863. DOI：10.3390/s23135863.
[15]	YAN K Q, WU Q S, YANG J. Blood pressure variability may be a new predictor for the occurrence and prognosis of ischemic stroke[J]. Chin Med Sci J，2019:2023060901. DOI：10.24920/004219.]
[16]	FLORAS J. Correspondence concerning："cardiovagal baroreflex sensitivity，blood pressure and blood pressure variability"[J]. J Hypertens，2023,41(6):1052. DOI：10.1097/HJH.0000000000003383.
[17]	童慧钰，苏海. 心房颤动患者动态血压监测的24 h脉率是否可以用于心率的评估?[J]. 中华高血压杂志，2023,31(1):10-12. DOI：10.16439/j.issn.1673-7245.2023.01.005.
[18]	SIBLE I J, Nation D A. Blood pressure variability and cerebral perfusion decline: a post hoc analysis of the SPRINT MIND trial[J]. Journal of the American Heart Association，2023,12(12):e029797. DOI：10.1161/JAHA.123.029797.
[19]	NUGENT J T, GHAZI L, YAMAMOTO Y，et al. Hypertension，blood pressure variability，and acute kidney injury in hospitalized children[J]. J Am Heart Assoc，2023,12(9):e029059. DOI：10.1161/JAHA.122.029059.
[20]	WU Z Y, ZHANG H P, WANG Y T，et al. Temporal and bidirectional association between blood pressure variability and arterial stiffness：cross-lagged cohort study[J]. JMIR Public Health Surveill，2023,9:e45324. DOI：10.2196/45324.
[21]	LUCCA M B, JORGE J A, CICHELERO F T，et al. Effects of chlorthalidone plus amiloride compared with amlodipine on short-term blood pressure variability in individuals with hypertension and obstructive sleep apnea: a randomized controlled trial[J]. Blood Press Monit，2023,28(6):289-294. DOI：10.1097/MBP.0000000000000663.
[22]	BANIASAD A, MOKHTARI A A, NAJAFZADEH M J，et al. The relationship between vitamin D and short-term blood pressure variability[J]. Blood Press Monit，2023,28(4):193-198. DOI：10.1097/MBP.0000000000000652.
[23]	LIU L B, ZHAO W C, CHEN L Q. Comparison of antihypertensive drugs amlodipine and perindopril on blood pressure variability after long-term treatment of hypertension induced by apatinib and bevacizumab[J]. Chin J Physiol，2023,66(3):137. DOI：10.4103/cjop.cjop-d-22-00158.
[24]	GUTTERIDGE D S, SEGAL A, MCNEIL J J，et al. The relationship between long-term blood pressure variability and cortical thickness in older adults[J]. Neurobiol Aging，2023,129:157-167. DOI：10.1016/j.neurobiolaging.2023.05.011.
[25]	SCHMALENBERGER K. Menstrual cycle，heart rate variability（HRV），and mood：is cyclicity of HRV associated with cyclicity of mood symptoms?[J]. Psychoneuroendocrinology，2023,153:106244. DOI：10.1016/j.psyneuen.2023.106244.
[26]	KAZE A D, YUYUN M F, FONAROW G C，et al. Blood pressure variability and risk of atrial fibrillation in adults with type 2 diabetes[J]. JACC Adv，2023,2(4):100382. DOI：10.1016/j.jacadv.2023.100382.
[27]	YANG E, TANG O. Exploring the impact of blood pressure variability on incident atrial fibrillation in type 2 diabetes[J]. JACC：Advances，2023,2(4). DOI：10.1016/j.jacadv.2023.100405.
[28]	SANTOS-DE-ARAÚJO A D, SHIDA-MARINHO R, PONTES-SILVA A. Heart rate variability（HRV）：checklist for observational and experimental studies[J]. Autoimmun Rev，2022,21(11):103190. DOI：10.1016/j.autrev.2022.103190.
[29]	LANGGUTH P, WOLF C, SEDAGHAT S，et al. Correction to: clinical value of using heart rate variability biofeedback before elective CT coronary angiography to reduce heart rate and the need for BetaBlockers[J]. Appl Psychophysiol Biofeedback，2023,48(4):403. DOI：10.1007/s10484-023-09596-0.
[30]	JAIN N, LEHRER H M, CHIN B N，et al. Heart rate and heart rate variability following sleep deprivation in retired night shift workers and retired day workers[J]. Psychophysiology，2023,60(12):e14374. DOI：10.1111/psyp.14374.

组别	例数	年龄（岁）	性别（男/女）	血脂指标
组别	例数	年龄（岁）	性别（男/女）	TC（mmol/L）	LDL-C（mmol/L）	HDL-C（mmol/L）	TG（mmol/L）
冠心病组	159	59.09±0.83	93/66	4.94±0.40	2.65±0.10	1.07±0.03	2.26±0.16
非冠心病组	87	62.16±1.26	48/39	4.43±0.12	2.46±0.09	1.26±0.08	1.92±0.13
t（χ²）值		4.343	0.253^a	-1.223	-1.530	1.687	-1.554
P值		<0.001	0.615	0.224	0.130	0.095	0.124
组别	心脏彩超指标					动态心电图			血压昼夜变异率（%）
组别	LVD （mm）	LVEF （%）	SV （mL）	EDV （mL）	CO （L/min）	SDNN	平均QT （ms）	平均QTc（ms）	血压昼夜变异率（%）
冠心病组	48.67±0.66	65.03±0.82	68.61±1.78	105.71±2.94	4.90±0.14	115.32±3.67	389.51±4.32	410.77±3.73	19.06±0.05
非冠心病组	47.24±0.55	65.04±0.84	73.88±1.99	113.96±3.73	5.18±0.18	106.76±3.52	392.72±3.66	412.77±3.27	9.98±0.03
t（χ²）值	-1.584	-0.009	-1.801	-1.643	-1.231	2.212	-0.575	-0.394	-14.620
P值	0.117	0.993	0.075	0.104	0.222	0.030	0.567	0.695	<0.001

组别	例数	年龄（岁）	性别（男/女）	血脂指标
组别	例数	年龄（岁）	性别（男/女）	TC（mmol/L）	LDL-C（mmol/L）	HDL-C（mmol/L）	TG（mmol/L）
冠心病组	159	59.09±0.83	93/66	4.94±0.40	2.65±0.10	1.07±0.03	2.26±0.16
非冠心病组	87	62.16±1.26	48/39	4.43±0.12	2.46±0.09	1.26±0.08	1.92±0.13
t（χ²）值		4.343	0.253^a	-1.223	-1.530	1.687	-1.554
P值		<0.001	0.615	0.224	0.130	0.095	0.124
组别	心脏彩超指标					动态心电图			血压昼夜变异率（%）
组别	LVD （mm）	LVEF （%）	SV （mL）	EDV （mL）	CO （L/min）	SDNN	平均QT （ms）	平均QTc（ms）	血压昼夜变异率（%）
冠心病组	48.67±0.66	65.03±0.82	68.61±1.78	105.71±2.94	4.90±0.14	115.32±3.67	389.51±4.32	410.77±3.73	19.06±0.05
非冠心病组	47.24±0.55	65.04±0.84	73.88±1.99	113.96±3.73	5.18±0.18	106.76±3.52	392.72±3.66	412.77±3.27	9.98±0.03
t（χ²）值	-1.584	-0.009	-1.801	-1.643	-1.231	2.212	-0.575	-0.394	-14.620
P值	0.117	0.993	0.075	0.104	0.222	0.030	0.567	0.695	<0.001

因素	B	SE	Wald χ^2值	P值	OR（95%CI）
年龄	0.072	0.028	0.778	0.009	1.075（1.018~1.135）
女性	-0.221	0.704	0.099	0.753	0.801（0.202~3.183）
TC	-0.902	0.662	1.855	0.173	0.406（0.111~1.486）
LDL-C	-0.559	0.560	0.996	0.318	0.572（0.191~1.714）
HDL-C	-0.077	0.671	0.013	0.908	0.926（0.249~3.449）
TG	0.038	0.658	0.003	0.954	1.039（0.286~3.771）
LVD	-4.342	1.460	8.842	0.003	0.013（0.001~0.228）
LVEF	0.817	0.730	1.254	0.263	2.264（0.542~9.464）
SV	0.520	0.630	0.683	0.409	1.683（0.490~5.782）
EDV	2.475	0.978	6.408	0.011	11.878（1.748~80.700）
CO	-1.436	0.724	3.932	0.047	0.238（0.057~0.983）
SDNN	-2.257	0.637	12.549	<0.001	0.105（0.030~0.365）
平均QT	-1.189	0.661	3.239	0.072	0.304（0.083~1.112）
平均QTc	-0.420	0.767	0.300	0.584	0.657（0.146~2.957）
血压昼夜变异率	5.612	0.859	42.667	<0.001	273.713（50.813~1 474.413）

因素	B	SE	Wald χ^2值	P值	OR（95%CI）
年龄	0.072	0.028	0.778	0.009	1.075（1.018~1.135）
女性	-0.221	0.704	0.099	0.753	0.801（0.202~3.183）
TC	-0.902	0.662	1.855	0.173	0.406（0.111~1.486）
LDL-C	-0.559	0.560	0.996	0.318	0.572（0.191~1.714）
HDL-C	-0.077	0.671	0.013	0.908	0.926（0.249~3.449）
TG	0.038	0.658	0.003	0.954	1.039（0.286~3.771）
LVD	-4.342	1.460	8.842	0.003	0.013（0.001~0.228）
LVEF	0.817	0.730	1.254	0.263	2.264（0.542~9.464）
SV	0.520	0.630	0.683	0.409	1.683（0.490~5.782）
EDV	2.475	0.978	6.408	0.011	11.878（1.748~80.700）
CO	-1.436	0.724	3.932	0.047	0.238（0.057~0.983）
SDNN	-2.257	0.637	12.549	<0.001	0.105（0.030~0.365）
平均QT	-1.189	0.661	3.239	0.072	0.304（0.083~1.112）
平均QTc	-0.420	0.767	0.300	0.584	0.657（0.146~2.957）
血压昼夜变异率	5.612	0.859	42.667	<0.001	273.713（50.813~1 474.413）