Correlação entre índices lineares da variabilidade da frequência cardíaca de repouso com sinais e sintomas em programas de reabilitação cardiovascular
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Data
2018-12-13
Autores
Takahashi, Carolina [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Programas de reabilitação cardiovascular (PRC) podem promover controle de fatores de risco cardiovascular e redução da incidência de novas complicações coronarianos, porém a prática de exercício físico pode ser associada com o risco de surgimento de sinais e sintomas durante o seu desenvolvimento. A variabilidade da frequência cardíaca (VFC) vem sendo utilizada para realizar a monitorização e prognóstico de mortalidade, contudo será que índices de VFC podem ser utilizados para predizer sinais e sintomas em indivíduos que frequentam PRC? Se sim, quais os índices que melhor se correlacionam com a possibilidade de sinais e sintomas nesses programas? Será possível, estabelecer um ponto de corte desses índices que possa melhor prever as chances do aparecimento de sinais e sintomas nesses programas? Objetivo: Analisar a correlação entre os índices da VFC mensurados em repouso com a presença de sinais/sintomas em participantes de um PRC e determinar pontos de corte dos índices lineares da VFC, utilizando a curva ROC, para o surgimento de sinais e sintomas. Materiais e métodos: Foram analisados dados de 48 pacientes atendidos em um PRC. Foram realizadas avaliações em repouso da modulação autonômica e posteriormente, estes indivíduos foram acompanhados por um período de três meses durante as sessões do PRC para avaliação de sinais e sintomas. A relação entre o surgimento de sinais e sintomas dos pacientes e os valores das variáveis autonômicas foi analisada pela correlação de Pearson, quando dados normais e quando não, a correlação de Spearman. A definição dos pontos de corte, foi obtida pela curva Receiver Operating Characteristic (ROC), área sob a curva foi considerada significativa quando valores ≥ 0,650 foram obtidos. Todos os resultados foram discutidos no nível de 5% de significância. Resultados: Ocorreram no total 103 sinais/sintomas, sendo os mais recorrentes as alterações de pulso (61,16%) e dor muscular (19,42%). Menores valores em pNN50, HF (ms²) e SD1/SD2 foram observados no grupo que apresentou sinais e sintomas, todos tendo tamanho de efeito alto. Além disso, os índices rMSSD, pNN50, HF (ms²), SD1 e SD1/SD2 apresentaram correlação negativa significativa com o surgimento dos sinais/sintomas. A partir da curva ROC observamos que os índices rMSSD, SDNN, LF (ms²), HF (ms²), LF (un), HF (un), potência total, SD1 e SD2 apresentaram boa sensibilidade para detecção de indivíduos que possam apresentar sinais/sintomas, porém com uma especificidade reduzida. Para os índices pNN50, VLF e relação SD1/SD2 houve uma boa especificidade, porém com uma sensibilidade reduzida. Conclusão: Os índices rMSSD, pNN50, HF (ms²), SD1 e SD1/SD2 apresentam correlação negativa com o surgimento de sinais/sintomas de pacientes em PRC. Foi possível obter pontos de corte dos índices autonômicos e os valores na curva ROC foram moderados, apresentando boa especificidade e reduzida sensibilidade, ou o inverso.
Cardiovascular rehabilitation programs (CRP) may promote control of cardiovascular risk factors and reduce the incidence of new coronary events, but physical exercise may be associated with the risk of signs and symptoms arising during its development. Heart rate variability (HRV) has been used to perform mortality monitoring and prognosis, but can HRV rates be used to predict intercurrences in individuals who attend PRC? If so, which indexes best correlate with the possibility of intercurrences in these programs? Is it possible to establish a cutoff point for these indices that can better predict the chances of the occurrence of intercurrences in these programs? Objective: To analyze the correlation between the HRV indices measured at rest with the presence of signs/symptoms in participants of a PRC and to determine cutoff points of HRV linear indices, using the ROC curve, for the occurrence of intercurrences. Materials and methods: Data from 48 patients seen in a CRP were analyzed. Resting evaluations of autonomic modulation were performed and, later, these individuals were followed up for a period of three months during the PRC sessions to assess intercurrences. The relationship between the occurrence of patient intercurrences and the values of the autonomic variables was analyzed by Pearson's correlation, when normal data and when not, the Spearman correlation. The definition of cut-off points was obtained by the Receiver Operating Characteristic (ROC) curve, area under the curve was considered significant when values ≥ 0.650 were obtained. All results were discussed at the 5% level of significance. Results: A total of 103 signs/symptoms, being the most recurrent ones such as changes in pulse (61.16%) and muscle pain (19.42%). Lower values in pNN50, HF (ms²) and SD1/SD2 were observed in the intercurrent group. In addition, the rMSSD, pNN50, HF (ms²), SD1 and SD1/SD2 indices were associated with the onset of signs/symptoms, all having high effect size. From the ROC curve we observed that the rMSSD, SDNN, LF (ms²), HF (ms²), LF (un), HF (un), total power, SD1 and SD2 indices showed good sensitivity for detection of individuals who may show signs symptoms, but with reduced specificity. For the indices pNN50, VLF and SD1/SD2 ratio there was a good specificity, but with a reduced sensitivity. Conclusions: The indices rMSSD, pNN50, HF (ms²), SD1 and SD1/SD2 present a negative correlation with the appearance of signs/symptoms of patients in CRP. It was possible to obtain cutoff points for the autonomic indexes and the values in the ROC curve were moderate, presenting good specificity and reduced sensitivity, or the inverse.
Cardiovascular rehabilitation programs (CRP) may promote control of cardiovascular risk factors and reduce the incidence of new coronary events, but physical exercise may be associated with the risk of signs and symptoms arising during its development. Heart rate variability (HRV) has been used to perform mortality monitoring and prognosis, but can HRV rates be used to predict intercurrences in individuals who attend PRC? If so, which indexes best correlate with the possibility of intercurrences in these programs? Is it possible to establish a cutoff point for these indices that can better predict the chances of the occurrence of intercurrences in these programs? Objective: To analyze the correlation between the HRV indices measured at rest with the presence of signs/symptoms in participants of a PRC and to determine cutoff points of HRV linear indices, using the ROC curve, for the occurrence of intercurrences. Materials and methods: Data from 48 patients seen in a CRP were analyzed. Resting evaluations of autonomic modulation were performed and, later, these individuals were followed up for a period of three months during the PRC sessions to assess intercurrences. The relationship between the occurrence of patient intercurrences and the values of the autonomic variables was analyzed by Pearson's correlation, when normal data and when not, the Spearman correlation. The definition of cut-off points was obtained by the Receiver Operating Characteristic (ROC) curve, area under the curve was considered significant when values ≥ 0.650 were obtained. All results were discussed at the 5% level of significance. Results: A total of 103 signs/symptoms, being the most recurrent ones such as changes in pulse (61.16%) and muscle pain (19.42%). Lower values in pNN50, HF (ms²) and SD1/SD2 were observed in the intercurrent group. In addition, the rMSSD, pNN50, HF (ms²), SD1 and SD1/SD2 indices were associated with the onset of signs/symptoms, all having high effect size. From the ROC curve we observed that the rMSSD, SDNN, LF (ms²), HF (ms²), LF (un), HF (un), total power, SD1 and SD2 indices showed good sensitivity for detection of individuals who may show signs symptoms, but with reduced specificity. For the indices pNN50, VLF and SD1/SD2 ratio there was a good specificity, but with a reduced sensitivity. Conclusions: The indices rMSSD, pNN50, HF (ms²), SD1 and SD1/SD2 present a negative correlation with the appearance of signs/symptoms of patients in CRP. It was possible to obtain cutoff points for the autonomic indexes and the values in the ROC curve were moderate, presenting good specificity and reduced sensitivity, or the inverse.
Descrição
Palavras-chave
Serviço de reabilitação, Rehabilitation service, ROC curve, Sinais e sintomas, Sistema nervoso autônomo, Curva ROC, Signals and symptons, Autonomic nervous system