扩张型心肌病患者窦性心率震荡的研究

Prognostic significance of heart rate turbulence in patients with dilated cardiomyopathy

目的探讨扩张型心肌病患者窦性心律震荡(HRT)的特征及其对预后的影响。方法选择扩张型心肌病并室早的患者187例,选择同期有室早而无器质性心脏病100例作对照组,分别检测窦性心率震荡的初始(TO)和窦性心率震荡的斜率(TS):将窦性心率震荡分类为HRT1(TO<0且TS>2.5ms/RR间期)、HRT2(TO≥0或TS≤2.5ms/RR间期)、HRT3(TO≥0且TS≤2.5ms/RR间期),分别对不同心功能分级,存活组及死亡组进行分析。结果扩张型心肌病与对照组比较TO、TS均有显著性差异(P<0.001和P<0.005)。在心功能Ⅲ级与Ⅳ级时HRT2在两组间无显著性差异(p>0.05),其他不同分级心功能的窦性心率震荡分类均有显著差异(p<0.05或p<0.01)。存活组与死亡组比较窦性心率震荡分类亦有显著性差异(HRT1p<0.01,HRT2p<0.05,HRT3p<0.01)。结论扩张型心肌病患者存在室早后窦性心率震荡减弱或消失现象,窦性心率震荡对其预后有一定的预测价值。

Objective To explore the feature and the effect of heart rate turbulence （HRT） on dilated cardiomyopathy. Methods 187 dilated cardiomyopathy patients with ventricular premature beat were enrolled, compared with 100 cases with ventircular premature beat but not with heart disease. All patients were divided into living group, death group and different cardiac function groups. The turbulence onset （TO） and turbulence slope （TS） of HRT were inspected individually and the categories of HRT between groups were analyed. The HRT was categoried into three： HRT1 with TO〈0 and TS〉2.5ms/RRinterval, HRT2 with TO≥0 or TS ≤2.5ms/RRinterval, HRT3 with TO ≥0 and TS ≤2.5ms/RRinterval. Rerults Among the different cardiac function groups, HRT categories have remarkable difference expect between NYHA Ⅲ and Ⅳ subgroups. Between living group and death group HRT categories show significant differences（HRT1 p〈0.01, HRT2 p〈0.05, HRT3 p〈0.01）. Conclusions Decreasing and disappearing phenomenon of HRT are observed in dilated cardiomyopathy patients. HRT shows definite value as a predictor index of the mortality of dilated cardiomyopathy.