心率振荡对ACS患者预后的临床预测

Significance of heart rate turbulence in patients with acute coronary syndrome

目的评价心率振荡现象对急性冠脉综合征(ACS)患者心血管事件的预测价值。方法入选患者72例,不稳定型心绞痛41例,急性心肌梗死31例;Holter示室性早搏≥2个。分析Holter文件,取得心率振荡参数:振荡初始(TO)和振荡斜率(TS);同时获取临床资料、超声心动图检测的左室舒张末径、左室射血分数和心率变异参数。根据随访结果将患者分成有或无心血管事件组,分析两组各变量对心血管事件的预测价值。结果两组平均随访(32±16)个月,12例发生心血管事件,单变量分析显示TO≥0(P<0.05)和TS≤2.5ms/RR(P<0.01)均为心血管事件的强力预测因子,多变量回归分析示仅TS≤2.5ms/RR(P<0.05)和年龄≥65岁(P=0.055)为心血管事件的独立预测指标。结论心率振荡现象减弱或消失,尤其是异常振荡斜率(TS≤2.5ms/RR),是ACS患者心血管事件强力且独立的预测指标。

Objective To study the clinical significance of heart rate turbulence （HRT） in predicting the prognosis of patients with acute coronary syndrome（ACS）. Methods Seventy-two patients with ACS and ventricular premature beats （≥2） recorded by Holter monitoring were collected. The Holter files were processed to obtain the values of turbulence onset （TO） and turbulence slope （TS）. Clinical information, LVEF, EDD measured by ultrasonic cardiography and heart rate variability （HRV） were also obtained. Predictive values of variables on cardiovascular events were analyzed. Results Both TO≥ 0 and TS≤ 2.5 ms/RR were powerful predictors of cardiovascular events by univariate analysis （P〈0. 05 and P〈0. 01）. By multivariate analysis, only abnormal TS（ TS≤ 2.5 ms/RR） and age （ ≥ 65 years） were independent predictors. Conclusion Impaired HRT, especially abnormal TS（TS≤2.5 ms/RR）, is a powerful factor for predicting the cardiovascular events in patients with ACS.