老年心力衰竭患者心率震荡变化的临床意义

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

目的分析老年慢性心力衰竭患者窦性心率震荡(HRT)现象的变化并探讨其临床意义。方法对57例老年慢性心力衰竭患者(心衰组)和49名老年非器质性心脏病患者(对照组)24h动态心电图(Holter)进行分析,分别计算HRT的震荡初始值(TO)和震荡斜率(TS),并进行TO、TS与左心室射血分数(LVEF)、左心室舒张末期内径(LVEDd)的相关性分析。结果心衰组与对照组HRT间存在明显差别:心衰组TO明显高于对照组(0.99±2.26vs-1.84±2.13,P<0.01);心衰组TS明显低于对照组[(2.87±1.89)ms/RRvs(8.03±3.51)ms/RR,P<0.05]。TO、TS与LVEF、LVED有相关性。结论老年慢性心力衰竭患者中HRT出现钝化趋势,TO、TS值变化作为老年心力衰竭患者预后和危险程度评估的一项参数有一定参考意义。

Objective To explore the clinical significance of heart rate turbulence （HRT） in elderly patients with chronic heart failure（CHF）. Methods Turbulence onset （TO） and turbuience slope （TS） were measured in 57 elderly patients with CHF and 49 elderly patients without organic heart disease （control group） according to their Holter records, and compared with the clinical characeristics. Results TO was significantly higher in patients with CHF than that in control group（0.99 ± 2.26 vs. - 1.84 ± 2.13, P〈 0.01）. TS was significantly lower in patients withCHF than that in control group[（2. 87 ±4-1. 89） ms/RR vs. （8.03±3.51）ms/RR,P〈0. 05]. In patients with CHF, the coefficient correlation between TO and LVEF, LVEDd was -0. 328 and 0. 274 respectively （P〈 0.01, P〈 0.05）, the coefficient correlation between TS and LVEF, LVEDd was 0. 281 and -0. 317 respectively （P〈0.05, P〈0.05）. Conclusions HRT is significantly blunted in elderly patients with CHF and may act as a new predictor of poor prognosis in elderly patients with CHF.