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Intérêt de la variabilité du rythme cardiaque comme marqueur de risque

Abstract : The heart rate variability (HRV) has arisen as a promising simple and non invasive biomarker of autonomic nervous system (ANS) function, through its effects on the heart. Multiple studies have shown that the decrease in the HRV is associated usually with poor prognosis. We proposed to further investigate the HRV in other domains of clinical application, including cardiac or extra-cardiac pathologies. In particular, the pathological contexts in which the ANS plays an important role :1-Traffic road accident (RTA) and the risk of development of post traumatic stress disorders (PTSD) in survivors.2-Effect of pain and of epidural analgesia on maternal HRV during childbirth.3-Genetic polymorphisms of beta adrenergic receptors (β-AR) in patients with left ventricular dysfunction and implanted with an implantable cardioverter defibrillator (ICD) for secondary prevention. At first, our study is the first to show that the temporal analysis of 24-h HRV is not only a predictive factor of the occurrence of PTSD but also its severity among victims of RTA AVP. The variability index was the best predictor of PTSD with the area under the receiver-operating curve for discriminating PTSD at 6 month at 0.92 (95% CI:0.785;1.046). Acut-off at 2.19% yielded a sensitivity of 85.7% and a specificity of 81.8% for PTSD. Positive and negative predictive values were respectively 75% and 90%. At next, we showed that the ANI, which reflects the influence of ventilation on heart rate, allows an objective measure of pain in conscious subjects? At last, we found that patients with the substitutions Arg (instead of Gly) at position 16 and Gln (instead of Glu) at position 27 for β2-AR have a lower HRV value than patients with wild type receptor.
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https://tel.archives-ouvertes.fr/tel-00840217
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Submitted on : Tuesday, July 2, 2013 - 1:04:14 AM
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Abeer Shaikh Al Arab. Intérêt de la variabilité du rythme cardiaque comme marqueur de risque. Médecine humaine et pathologie. Université du Droit et de la Santé - Lille II, 2012. Français. ⟨NNT : 2012LIL2S005⟩. ⟨tel-00840217⟩

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