心率减速力预警高危肥厚型心肌病患者的临床价值

Clinical value of deceleration capacity of heart rate in predicting high-risk patients with hypertrophic cardiomyopathy

目的探讨心率减速力在评价肥厚型心肌病患者自主神经功能方面的应用以及对高危患者进行预警方面的临床价值。方法分析19例肥厚型心肌病患者和21例健康体检者的24 h动态心电图检查资料,分别将两组作为观察组和对照组。比较两组的心率减速力及心率变异性时域指标(SDNN、rMSSD),并研究观察组的心率减速力与心率变异性各指标之间的关系。结果观察组的心率减速力及心率变异性时域指标均比对照组低,差异均有统计学意义(P<0.05);且该组异常心率减速力的发生率高达84.2%,明显高于正常对照组(P<0.05)。相关分析结果显示,观察组的心率减速力与心率变异性时域指标中的SDNN呈正相关(r=0.618,P<0.05),与rMSSD也呈正相关(r=0.557,P<0.05)。平均随访48个月,其中心率减速力高风险组猝死率明显高于低风险组。结论肥厚型心肌病患者的心率减速力数值明显降低,和心率变异性时域指标有较好的正相关性,可作为定量检测肥厚型心肌病患者自主神经功能以及筛选高危患者的新的可靠指标。

Objective To investigate the applications of deceleration capacity of heart rate(DC)in assessment of autonomic nervous function in patients with hypertrophic cardiomyopathy(HCM) and discuss its clinical value in predicting high-risk patients. Methods Nineteen HCM patients’ and 21normal persons’ 24 h ambulatory electrocardiography data were analyzed. The two groups were regarded as observation group and control group respectively. DC and HRV time domain indexes(SDNN,rMSSD) were compared between two groups of patients while the relationship between DC and HRV indexes of the observation group were studied with statistical software. Results DC and HRV time domain indexes of the observation group were lower than those of control group,with statistically significant differences. The incidence of abnormal DC in observation group was as high as 84. 2%,significantly higher than that of control group(P&lt;0. 05). It was implied by relevant analytic results that in observation group,DC was positively correlated with SDNN(r = 0. 618,P &lt; 0. 05) as well as rMSSD( r =0.557,P&lt;0.05). The incidence of sudden death in DC high-risk group was significantly higher than that of DC low-risk group during a 48-month follow-up. Conclusion DC of HCM patients significantly decreases and has good positive correlation with HRV time domain indexes(SDNN,rMSSD).Therefore,DC can be utilized as a new reliable index for quantitatively detecting autonomic nervous function of HCM patients and screening high-risk cases among them.