Reduced heart rate variability (HRV) is an autonomic nervous system (ANS) response that may indicate dysfunction in the human body. Consistent evidence shows cancer patients elicit lower HRV; however, only select cancer locations were previously evaluated. Thus, the aim of the current study was to explore HRV patterns in patients diagnosed with and in varying stages of the most prevalent cancers. At a single tertiary academic medical center, 798 patients were recruited. HRV was measured via an armband monitor (Warfighter MonitorTM, Tiger Tech Solutions, Inc., Miami, FL, USA) equipped with electrocardiographic capabilities and was recorded for 5 to 7 min with patients seated in an upright position. Three time-domain metrics were calculated: SDNN (standard deviation of the NN interval), rMSSD (the root mean square of successive differences of NN intervals), and the percentage of time in which the change in successive NN intervals exceeds 50ms within a measurement (pNN50). Of the 798 patients, 399 were diagnosed with cancer. Cancer diagnoses were obtained via medical records one week following the measurement. Analysis of variance models were performed comparing the HRV patterns between different cancers, cancer stages (I–IV), and demographic strata. A total of 85% of the cancer patients had breast, gastrointestinal, genitourinary, or respiratory cancer. The cancer patients were compared to a control non-cancer patient population with similar patient size and distributions for sex, age, body mass index, and co-morbidities. For all HRV metrics, non-cancer patients exhibited significantly higher rMSSDs (11.1 to 13.9 ms,p< 0.0001), SDNNs (22.8 to 27.7 ms,p< 0.0001), and pNN50s (6.2 to 8.1%,p< 0.0001) compared to stage I or II cancer patients. This significant trend was consistently observed across each cancer location. Similarly, compared to patients with stage III or IV cancer, non-cancer patients possessed lower HRs (−11.8 to −14.0 bpm,p< 0.0001) and higher rMSSDs (+31.7 to +32.8 ms,p< 0.0001), SDNNs (+45.2 to +45.8 ms),p< 0.0001, and pNN50s (19.2 to 21.6%,p< 0.0001). The HR and HRV patterns observed did not significantly differ between cancer locations (p= 0.96 to 1.00). The depressed HRVs observed uniformly across the most prevalent cancer locations and stages appeared to occur independent of patients’ co-morbidities. This finding highlights the potentially effective use of HRV as a non-invasive tool for determining common cancer locations and their respective stages. More studies are needed to delineate the HRV patterns across different ages, between sexes and race/ethnic groups.
心率变异性降低是自主神经系统的一种反应，可能提示人体功能失调。现有充分证据表明癌症患者心率变异性较低，但既往研究仅针对特定部位的癌症。因此，本研究旨在探讨最常见癌症类型及其不同分期患者的心率变异性特征。研究在单一三级学术医疗中心招募798名患者，采用具备心电图功能的臂带式监测仪（Warfighter MonitorTM，美国佛罗里达州迈阿密Tiger Tech Solutions公司）测量心率变异性。患者在直立坐姿状态下接受5-7分钟监测，计算三个时域指标：NN间期标准差、相邻NN间期差值的均方根以及测量期间相邻NN间期变化超过50毫秒的时间占比。在798名患者中，399人被确诊患有癌症，癌症诊断信息于测量一周后从医疗记录中获取。通过方差分析模型比较不同癌症类型、癌症分期（I-IV期）及人口统计学分层的心率变异性特征。结果显示85%的癌症患者患有乳腺、胃肠道、泌尿生殖系统或呼吸系统癌症。将癌症患者与规模相当、性别、年龄、体重指数及合并症分布相似的对照组非癌症患者进行比较。所有心率变异性指标均显示：与I期或II期癌症患者相比，非癌症患者的相邻NN间期差值的均方根（11.1-13.9毫秒，p<0.0001）、NN间期标准差（22.8-27.7毫秒，p<0.0001）及相邻NN间期变化超过50毫秒的时间占比（6.2-8.1%，p<0.0001）均显著更高，该显著趋势在所有癌症部位中均一致存在。同样，与III期或IV期癌症患者相比，非癌症患者具有更低的心率（降低11.8-14.0次/分，p<0.0001）及更高的相邻NN间期差值的均方根（增加31.7-32.8毫秒，p<0.0001）、NN间期标准差（增加45.2-45.8毫秒，p<0.0001）和相邻NN间期变化超过50毫秒的时间占比（增加19.2-21.6%，p<0.0001）。不同癌症部位之间的心率和心率变异性特征无显著差异（p=0.96-1.00）。在最常见癌症部位和分期中观察到的心率变异性降低现象似乎与患者合并症无关。这一发现凸显了心率变异性作为无创工具在确定常见癌症部位及其对应分期方面的潜在应用价值。未来需要更多研究来阐明不同年龄、性别和种族/族裔群体间的心率变异性特征差异。
Tracking Cancer: Exploring Heart Rate Variability Patterns by Cancer Location and Progression
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