窦性心律震荡和QT离散度对老年慢性心功能不全猝死的预测价值比较

Predictive value of sinus heart rate turbulance and QTd to sudden death in elderly chronic heart failure

目的 探讨窦性心律震荡(heartrateturbulence,HRT)对老年慢性心功能不全猝死的预测价值及与QTd的比较。方法慢性心功能不全患者82例,LVEF>0.45组35例,LVEF0.35-0.45组38例,LVEF0.25-0.34组9例。存活50例,死亡32例,其中猝死16例。全部进行TO、TS、QTd测量并比较。结果存活组与猝死组比较差异显著(x2=18.96,P<0.01);LVEF>0.45组与LVEF0.35-0.45组比较差异不显著(x1=3.05,P>0.05),LVEF0.35-0.45组与LVEF0.25-0.34组比较差异显著(x2=6.13,P<0.01),LVEF>0.45组与LVEF0.25-0.34比较差异显著(x2=12.84,P<0.01);在各组中TO/TS异常比QTd异常例数略多,但均未达到统计学意义(P>0.05)。结论窦性HRT和QTd对慢性心功能不全患者危险程度评估都是一种简便、有效的方法之一,但由于窦性HRT需要在有室早时才能检测,故在临床应用中受到一定限制,二者可以互相补充。

Objective To explore the predictive value of sinus heart rate turbulence to the sudden death in elderly chronic cardie insufficiency and compare with QTd. Methods 82 chronic cardiac insufficiency patients,35 patients LVEF>0. 45,38 patients LVEF 0. 35-0. 45 and 9 patients LVEF 0. 25-0. 34,50 patients survived,among the 32 patients died, 16 patients were sudden death. All of the ECGs of 82 patients were measured and compare the TO、TS、QTd with each other. Results The difference between survival team and sudden death team is significant(x2=18. 96,P< 0. 01 ) ,the difference between LVEF> 0. 45 team and LVEF 0. 25-0. 34 team is significant(x2=12. 84,P< 0. 01 )、LVEF 0. 35-0. 45 and LVEF 0. 25-0. 34 team is significant(x2=6. 13,P < 0. 01 ). Conclusions Sinus heart rate turbulence and QT dispersion are simple,effective method to asses the risk of chronic cardiac insufficiency. But sinus heart rate tubulence can be measured only when there is a ventricular premature beat,there are some limit in clinic usage. Two indexes can complement each other.