心率震荡对心力衰竭患者死亡的预测价值及药物对心率震荡的影响

The prognostic value and medication response of heart rate turbulence in heart failure patients

目的评价心率震荡(HRT)对心力衰竭患者死亡的预测价值及β受体阻滞剂对HRT的影响。方法133例心力衰竭患者和52名正常对照者均记录临床资料、行超声心动图、动态心电图(Holter)检查。其中33例患者在服用β受体阻滞剂前和服用6个月后均行Holter检查。HRT包括两个参数:震荡初始(TO)和震荡斜率(TS),根据TO、TS组成不同分为HRT0、HRT1和HRT2。随后进行随访,终点事件是患者心源性死亡。根据以往危险分层的界定点设定高危因子,评判各因子预测能力。结果β受体阻滞剂治疗6个月后TS显著高于治疗前(P<0.05)。随访6￣40个月,平均(19±11)个月,14例死亡,119例存活,死亡组TS明显低于存活组(P<0.05);单变量分析显示HRT2具有最强的预测意义(P<0.01);多变量分析结果显示左心室射血分数(LVEF)≤35%、HRT2为仅有的2个对终点事件有预测价值的变量(P<0.05);生存曲线表明HRT2组预后最差(P<0.01)。结论HRT是心力衰竭患者死亡的独立预测指标。β受体阻滞剂可改善心力衰竭患者HRT异常。

Objective To investigate the prognostic value and medication response of heart rate turbulence （HRT）in heart failure patients. Methods One hundred thirty-three heart failure patients and 52 healthy subjects were. recorded for their clinical data, left ventricular ejection fraction and 24-hour Hoher findings to collect the two parameters of HRT, turbulence onset （TO） and turbulence slope （TS）. In addition, thirty-three of the heart failure patients underwent 24-hour Hoher before and 6 months after beta-blocker therapy. The patients were further sub- grouped based on following HRT categories： HRT0 if both TO and TS were normal, HRT1 if either TO or TS was abnormal, or HRT2 if both TO and TS were abnormal. The primary endpoint was cardiac mortality. High risk factors were defined according to breakpoints previously used for risk stratification. Results TS was higher significantly after beta-blocker therapy for 6 months（P〈0.05）, During a follow-up of 6～40 （19±11） months,14 patients died and 119 survived. The TS of the death cases were significantly lower than those of the survivors （P〈0.05）. Univariate analysis showed that HRT2 was the strongest predictor of death （P〈0.01）; by multivariate analysis, only HRT2 and left ventricular ejection fraction proved prognostic of the primary endpoint （P〈0.05）. Survival curve suggested that HRT2 group had the worst prognosis （P〈0.01）. Conclusion HRT abnormality caused by heart failure can be ameliorated by beta-blocker therapy. HRT is au independent predictor of cardiac death in high-risk heart failure.