ISSN: 1223-1533

< Return to the list of articles

COMPARISON OF NEUROPHYSIOLOGICAL METHOD TO ASSESS SYMPATHETIC NERVOUS SYSTEM AND THE PARAMETERS OBTAINED FROM THE 24 - HOUR AMBULATORY HOLTER MONITORING.


Authors: Urszula Cieslik-Guerra , Michal Fila, Marek Kaminski, Jakub Chlapinski, Ewa Trzos, Barbara Uznanska-Loch, Tomasz Rechcinski, Jaroslaw Kasprzak, Andrzej Bogucki, Malgorzata Kurpesa




 

Purpose: Parameters derived from 24-hour ECG Holter analysis provides a non-invasive useful assessment of the parasympathetic and sympathetic nervous systems (SNS). There is still under discussion whether they represent balance of all autonomic nervous system (ANS) or its specific sympathetic and parasympathetic part.

Our study is dedicated to compare the results of neurophysiologic assessment of SNS and parameters derived from 24-hour Holter ECG analysis. We try also to select the parameters dependent of SNS activity.

 

Methods: The study group consisted of 52 patients aged 59.56 +/- 9.11 yrs (41male) after troponin-positive acute coronary syndrome (1-6 months before they were included). In all of the pts direct recording of SSR potentials (Keypoint, Medtronic, Copenhagen, Denmark ) on both hands and feet was performed. Latency (L) and amplitude (A) of potentials were measured.

 

 

Table 16.1. Correlations observed between latency of potentials of SSR on hand and parameters derived from 24-hour Holter ECG analysis.

 

 

 

Table 16.1. Correlations observed between latency of potentials of SSR on hand and parameters derived from 24-hour Holter ECG analysis.

 

 


 

In all pts ECG Holter monitoring was performed using DMS monitors and analysis software CardioScan 12 (DMS, Stateline, USA). Heart rate variability (HRV) was analyzed with time- and frequency domain methods to calculate: the standard deviation of all normal RR intervals (SDNN), the mean of all the 5-minute standard deviations of RR (SDNN index), the standard deviation of all the 5-minute RR interval means (SADNN index), the root-mean-square successive difference (rMSSD), the percentage of differences between successive RR intervals over 24 hours that are greater than 50 ms (pNN50) and total power spectrum (TPS), very low frequency (VLF), low frequency (LF), high frequency (HF) of spectrum. Premature ventricular contractions were observed and analyzed for turbulence onset (To) and slope (Ts). We performed also deceleration capacity (DC) analyses using noncommercial software.

Kolmogorov-Smirnov test confirmed normal distribution of results of all measurements in study group. Linear regression analysis was performed to confirm the relationships between variables.

 

Results: Correlations observed between latency of potentials of SSR on hand and parameters derived from 24-hour Holter ECG analysis are presented in table 16.1. There were no significant correlations between parameters derived from 24-hour Holter ECG analysis and SSR potential measured on lower limbs.

 

Conclusions: Parameters of Holter ECG analysis that the most significantly correlated with neurophysiologic assessment of SNS (latency of SSR potentials on hands) were: SDNN, SDNN index, SDANN index, VLF. We can suspect that they represent sympathetic activity. Parameters which more weakly correlated with neurophysiologic assessment of SNS (latency of SSR potentials on hands) were: TPS, LF, Ts, DC, AC. We suspect that they depend both on the sympathetic and parasympathetic activity.

Parameters which didn’t correlate with neurophysiologic assessment of SNS (latency of SSR potentials on hands) were: rMSSD, pNN50, HF, To. We suspect that their value depend on parasympathetic activity and other factors.