窦性心率震荡对急性冠脉综合征的诊疗价值

CLINICAL SIGNIFICANCE OF HEART RATE TURBULENCE ON PATIENTS WITH ACUTE CORONARY SYNDROME

目的探讨窦性心率震荡(heart rate turbulence,HRT)在急性冠脉综合征(acute coronary syndrome,ACS)患者诊疗中的临床价值。方法选择2005年1月—2008年2月在我院心内科住院并确诊的ACS患者160例,其中不稳定型心绞痛57例,急性心肌梗死103例,健康对照组57例,所有入选患者均接受动态心电图检查,测量HRT的参数TO、TS、心率变异的参数SDNN及左室射血分数(left ventricular ejection fraction,LVEF)。结果ACS患者HRT较正常健康人群显著减弱,急性心肌梗死患者HRT减弱更加明显,ACS患者HRT减弱程度与LVEF呈显著负相关。结论HRT可作为检测ACS患者压力感受器敏感性减退和自主神经功能受损,尤其是迷走神经反射功能受损以及判断ACS患者心功能状态的有价值参考指标。

Objective To study the changes and clinical significances of heart rate turbulence in patients with acute coronary syndrome. Methods Total 160 patients with acute coronary syndrome in the heart medicine wards of our hospital were chosen from Jan. 2005 to Feb. 2008. Among them, there were 57 patients suffered with unstable angina pectoris, and 103 patients with myocardial infraction. 57 control subjects without organic heart diseases were enrolled. All subjects were performed 24 - hour ambulatory electrocardiogram. The 24 - hour Holter records of each subject were processed by Holter 12.0 TOP Version HRT analysis software. HRT were stated by two parameters which including HRT onset （TO）, HRT slope（TS）. The parameters of HRT and heart rate variability （HRV） were obtained by software directly. Results Compared with the control group, the HRTs were lessened obviously in ACS patients. The HRTs lessened more obviously in patients with AMI than those with UAP. The imperfect degree of HRT was negatively related to LVEF in the ACS patients. Conlusion HRT can be used as a valuble referenced marker in patients with ACS to evaluate cardiac autonomic nerve function,baroreceptor sensitivity, vagus function and heart function as well.