窦性心率震荡现象对急性冠脉综合征预后的影响

The Significance of Heart Rate Turbulence as a Predictor for Prognosis of Acute Coronary Syndrome

目的分析窦性心率震荡现象(HRT)对急性冠脉综合征(ACS)患者预后的影响。方法自2005年9月—2007年12月因ACS入住某医院的患者共352例,其中入院2～3周内在24h动态心电图中发现室性早搏、并且室性早搏前至少有3个窦性心搏、室性早搏后至少有20个窦性心搏的患者共309例。通过测量室性早搏前后RR间期来测量HRT,同时收集其他影响ACS预后的相关指标如年龄、性别、吸烟、高血压、糖尿病、血脂异常、家族史、高尿酸血症、ACS类型、治疗方法、用药情况等。HRT根据震荡初始(TO)和震荡斜率(TS)的值分为正常(TO<0ms/RRI且TS>2.5ms/RRI)和异常(TO≥0ms/RRI或TS≤2.5ms/RRI)。随访时间为2a,一级终点为死亡,次级终点为需住院治疗的再发心血管事件(包括心力衰竭、再发ACS以及严重的心律失常)。结果309例ACS患者中男性190例,年龄(62.3±11.5)岁;女性119例,年龄(64.5±16.2)岁,平均随访(21.3±12.2)个月,死亡40例,次级终点84例。Logistic多元回归分析显示,死亡危险因素包括HRT异常及急性心肌梗死,其相关危险系数分别为48.69和34.92。非致死性心脏事件危险因素主要是HRT异常,其相关危险系数为12.86。结论HRT的异常提示ACS患者死亡及非致死性心脏事件的风险增加,HRT可能是评估ACS预后的可靠指标之一。

Objective To analyze the significance of heart rate turbulence as a predictor for prognosis of Acute Coronary Syndrome （include acute myocardial infarction and unstable angina pectoris）. Methods Three hundred and fifty-two inpatients with ACS were enrolled in our study since September in 2005 to December in 2007. Among them, three hundred and nine cases were confirmed diagnosis with 24 hr Holter electrocardiograms during the 2nd to 3rd week after hospitalization and met the following qualifications： first, the patients had a single ventricular premature beat in Hoher electrocardiograms; second, they experienced echocardiography examination and Left Ventricular Ejection Fraction was calculated by the area-length method; third, there were at least three sinus beats before ventricular premature beats and at least twenty sinus beats after that. HRT was calculated by measuring RR interval before and after ventricular premature beats, while some risk factors related to the prognosis of ACS were collected, including the age, sex, smoke, hypertension, diabetes mellitus, abnormal cholesterol, family history, high uric acid, type of Acute Coronary Syndrome, method of therapy, medication （such as Aspirin, Angiotensin Conversion Enzyme Inhibitor, Statins, and β-Blocker, etc.）. According to the values of turbulence onset （TO） and turbulence slope （TS）, HRT was divided into the normal （TO〈0 and TS〉2.5 ms/RRI） and the abnormal （TO ≥ 0 or （and） TS ≤ 2.5 ms/RRI）. All cases were followed up 2 years. Results Of 309 cases, 190 cases were male with age 62.3±11.5 years old, 119 were female with age 64.5±16.2 years old. The mean time of the follow-up was of 21±12.2 months, 40 patients died. With the logistic multivariate analysis, the results showed that HRT abnormal and acute myocardial infarction were the most significant predictors for death of ACS. The hazard ratio were 48.69（P〈0.05）and 34.92 （P〈0.05）. HRT abnormal was the most significant predictor of heart attack after ACS. The hazard ratio were 12.86 （P〈0.01）. Conclusion HRT may be a strong predictor for the prognosis of ACS.