充血性心力衰竭心率变异性改变及其与心室重塑的关系

Changes of heart rate variability and their relativity with ventricular remolding in patients with congestive heart failure

目的:检测充血性心力衰竭患者心率变异性(HRV)改变,探讨其与心室重塑的关系。方法:采用Holter检查系统检测了36例CHF患者HRV指标24h正常R-R间期标准差(SDNN)、24h内每5min平均正常R-R间期的标准差(SDANN)24h内每5min的正常R-R间期标准差的平均值(SDNNI),相邻正常R-R间期差值的均方根(rMSSD),相邻正常R-R间期差值≥50ms心搏数占总R-R间期数的百分数(PNN50)及超声心动图指标左心室舒张末期内径(LVEDD),收缩末期内径(LVESD),左心室后壁舒张末期厚度(LVPWT),心室间隔舒张末期厚度(IVST),左心室射血分数(LVEF),左心室舒张早期及舒张晚期充盈速度比值(E/A)及左心室重量指数(LVMI),并以20例健康体检者为对照。结果:CHF患者HRV各时域指标均下降,与对照组相比有显著差异(P<0.05～<0.01)。多元回归分析显示SDNN,SDNNI与LVEDD,LVPWT呈负相关(r=-0.337～-0.362,P<0.05);rMSSD,PNN50与LVEDD,LVESD呈负相关(r=-0.142～-0.433,P<0.05);rMSSD、PNN50与LVEF呈正相关(r=0.387～0.464,P<0.05～<0.001)。结论:CHF患者HRV下降,并与心室重塑有关。

Objective： To explore the changes of heart rate variability （HRV） and their correlated with ventricular remolding in patients with congestive heart failure （CHF）. Methods： The HRV parameters including SDNN, SDANN, SDNNI, rMSSD, PNN50 and echocardiographic parameters including LVEDD, LVESD, LVPWT, IVST, LVEF, E/A, LVMI were measured in 36 patients with CHF and 20 healthy controls. Results： HRV parameters of patients with CHF were significantly lower than that of controls. Multivariable analysis showed that LVEF was positive correlated with rMSSD, PNN50 （r=0. 387 - 0. 464, P〈0.05 - 〈0. 001） ;, LVEDD, LVESD were correlated with rMSSD and PNN50 （r=-0. 142--0. 433, P〈0.05）, and LVEDD, LVPWT were correlated with SDNN, SDNNI （r= -0. 337--0. 362, P〈0.05）. Conclusion： The HRV is decrease in patients with CHF and correlated with ventricular remolding.