心率震荡评价心力衰竭患者心功能的意义

Significance of heart rate turbulence for evaluating cardiac function in patient with congestive heart failure

目的:研究窦性心率震荡(HRT)在慢性心力衰竭患者中的变化,探讨其临床意义。方法:选择慢性心力衰竭伴室性期前收缩(PVS)患者47例为A组,有PVS但无器质性心脏病者45例为B组。所有受试者均进行心脏超声及24h动态心电图(DCG)检测,计算HRT指标:震荡起始(TO)、震荡斜率(TS)值及窦性心搏R-R间距的标准差(SDNN)。结果:A组的TO、LVEDD明显大于B组[(0.96±0.18)%∶(-2.81±3.12)%,(60.31±0.72)mm∶(47.66±2.62)mm];TS,SDNN,左室射血分数(LVEF)明显低于B组[(3.36±2.75)mm/RR∶(9.18±6.16)mm/RR,(81.03±22.51)ms∶(123.26±20.33)ms,(33.42±7.08)%∶(63.88±4.89)%,P均<0.001]。TO与LVEF呈负相关(r=-0.174,P<0.05),TS与LVEF呈正相关(r=0.246,P<0.01)。结论:慢性心力衰竭患者心率震荡起始升高,震荡斜率下降,它可能成为评价慢性心力衰竭患者自主神经功能状态的重要指标。

Objective： To study the significance of heart rate turbulence （HRT） on evaluation of cardiac function in patient with congestive heart failure. Methods： A total of 47 patients with congestive heart failure and premature ventricular systole （PVS） were regard as group A, and 45 PVS controls without heart disease were regard as group B. The HRT [contain turbulence onset （TO） and turbulence slope （TS）3 and left ventricular ejection fraction （LVEF） etc. were estimated in all subjects. Results：（1）TO, left ventricular end--diastolic dimension （LVEDD） of group A were more than those of group B [（0. 96±0.18）%： （-2.81±3.12）%, （60.31±0.72）mm： （47.66±2.62） mm]; TS, SDNN, LVEF were less than those of group B [（3.36±2.75） mm/RR：（9.18±6.16） mm/RR, （81.03±22.51） ms： （123.26±20.33） ms, （33.42±7.08）%： （63.88±4.89）%, P〈0.001 all]; （2） TO was negatively correlated with LVEF （r=-0. 174, P〈0.05）, TS was positively correlated with LVEF （r=0. 246, P〈0.01）. Conclusion： Turbulence onset increase and turbulence slope decrease in CHF patients, it may be significant index evaluating autonomic nerves function.