测定慢性心力衰竭患者窦性心率震荡的临床意义

Clinical significance of heart rate turbulence in patients with chronic heart failure

目的 观察慢性心力衰竭患者窦性心率震荡（heart rate turbulence,HRT）的变化,以及与左室射血分数（LVEF）、左室舒张末期内径（LVEDD）、心力衰竭积分的关系.方法 共入选慢性心力衰竭患者83例.分别计算HRT初始值（TO）、震荡斜率（TS）,对不同患者的TO、TS进行比较并分析TO和TS与LVEF、 LVEDD和心力衰竭积分的相关性.结果 随访12～22个月,平均（14±2）个月,死亡16例,因心力衰竭住院48例次.死亡患者与存活者相比TO显著升高[（2.4±1.2） % vs （0.9±1.2） %（P＜0.001）],而TS显著降低[（2.3±0.7） ms/RR vs （3.0±0.9） ms/RR（P＜0.001）];因心力衰竭住院患者与无住院患者相比TO显著升高[（1.9±1.3） % vs （0.3±0.7） %（P＜0.001）],而TS显著降低[（2.5±0.9） ms/RR vs （3.4±0.8） ms/RR（P＜0.001）].应用β-受体阻滞剂的患者与未应用者相比TO显著降低,而TS显著升高,分别为（0.6±0.8） % vs （2.5±1.3） %和（3.2±0.8） ms/RR vs （2.2±0.8） ms/RR,均P＜0.01;应用血管紧张素转换酶抑制剂的患者与没有应用者相比TO和TS无统计学意义,分别为（1.1±1.2） % vs （1.6±1.5） %和（2.9±0.9） ms/RR vs （2.8±1.0） ms/RR,均P＞0.05.TO与LVEDD和心力衰竭积分呈显著正相关,与LVEF呈显著负相关;TS与LVEDD和心力衰竭积分呈显著负相关,与 LVEF呈显著正相关,相关系数分别为0.62、0.74、-0.80、-0.46、-0.68和0.69,均P＜0.01.结论 慢性心力衰竭患者HRT现象减弱与心功能和预后密切相关,HRT可能成为预测慢性心力衰竭患者预后的一个新指标.

Objective To investigate the change of heart rate turbulence（HRT） in the patients with chronic heart failure（CHF） and its relationship with left ventricular ejection fraction（LVEF）, left ventricular end-diastolic diameter（LVEDD） and heart failure-score. Methods Eighty-three CHF patients were investigated. HRT onset（TO） and HRT slope（TS） were measured respectively,and their relevance with LVEF, LVEDD and heart failure-score was analyzed. Results During a follow-up of （14 ± 2） months （12- 22 months）, sixteen patients died and forty-eight patients were hospitalized due to worse heart failure. The value of TO was significantly higher and the value of TS was significantly lower in dead patients than in survivors[（2. 4 ± 1.2） % vs （0. 9 ± 1.2） % and （2. 3 ± 0. 7） ms/RR vs （3.1±0.9） ms/RR respectively（all P 〈0. 001）]. The value of TO was significantly higher and the value of TS was significantly lower in the hospitalized patients due to worse heart failure than non-hospitalized patients[（1.9± 1.3） % vs （0.3±0. 7） % and （2.5±0.9） ms/RR vs （3.4±0.8） ms/RR respectively（all P 〈0.001）]. The value of TO was significantly lower and the value of TS was significantly higher in the patients treated with β-blocker than those treated without β-blocker （0.6±0. 8） % vs （2.5±1.3） % and （3.2±0.8） ms/RR vs （2.2±0.8） ms/RR respectirely（all P 〈 0. 001）. There was no significant difference of TO and TS in the patients treated with and without angiotensinconverting enzyme inhibitor [（1.1 ± 1.2）% vs （1.6± 1.5）% and （2,9± 0.9） ms/RR vs （2,8± 1.0） ms/RR respectively（all P 〉0.05）]. There was significant positive correlation between TO and LVEDD, heart-failure score, TS and LVEF,and significant negative correlation between TS and LVEDD, heart-failure score, TO and LVEF（ r = 0. 62,0.74,0.69,-0.46,-0.68 and -0. 80,respectively,all P d0.001）. Couciusion There was a close relationship between blunted HRT and cardiac function. HRT may be a new prognostic predictor in the patients with CHF.