冠脉狭窄及血流改变与窦性心率震荡的相关性研究

Correlation between heart rate turbulence and coronary artery blood flow

目的:分析窦性心率震荡(HRT)各指标与冠状动脉病变程度及经皮冠状动脉介入治疗(PCI)前后血流的相关性。方法:选择90例同期行冠状动脉造影(CAG)和24h动态心电图(DCG)监测的患者,按CAG结果分为阳性组和阴性组,并对阳性组进行PCI治疗,对DCG所获得的HRT各项指标进行统计学分析和比较。结果:CAG阳性组患者的HRT参数震荡斜率[TS,(3.32±1.83)ms/RR]显著低于CAG阴性组的[(10.41±5.38)ms/RR,P<0.01],震荡起始[TO,(-0.81×10-2±0.60×10-2)%]显著高于CAG阴性组的[(-1.51×10-2±0.75×10-2)%,P<0.01]。CAG阳性组接受PCI治疗TIMI血流2级者TS值增加不明显,TO值下降不明显(P均0.05)TIMI血流3级者TS值明显增加[由(13.5±6.5)ms/RR增至(19.3±9.1)ms/RR,P<0.0001],TO值明显下降[由(-0.76×10-2±0.38×10-2)%降至(-2.13×10-2±0.37×10-2)%,P<0.0001],对冠脉病变与各项检测指标进行线性回归分析后发现,TS与冠脉的狭窄程度呈负相关(r=-0.62,P<0.01),与冠脉病变评分呈负相关(r=-0.527,P<0.05)。将冠脉按照病变程度进行分组发现,冠状动脉病变狭窄程度≥50%的TS值显著变小(P<0.01),多支病变的TS明显变小(P<0.05),冠脉病变评分高于10分组TS显著变小(P<0.05)。结论:冠心病患者的HRT参数显著降低,并且TS与冠状动脉粥样硬化严重程度有一定相关性,PCI治疗TIMI血流3级者HRT参数明显改善。

Objective： To study the correlation between heart rate turbulence （HRT） and coronary artery blood flow before and after PCI treatment. Methods： A total of 90 patients who had undergone 24h ambulatory electrocardiography （DCG） and selective coronary angiography （CAG） in the same period. The patients were divided into positive group and negative group （control group） according to the results of CAG. The positive group accepted PCI treat- ment. Then all of the data of HRT from DCG were analyzed and compared between groups. Results： Compared with those in control group, turbulence slope （TS） markedly reduced whereas turbulence onset （TO） significantly increased in coronary heart disease （CHD） patients （P〈0.01）. After PCI, TS increased [from （13.5±6.5） ms/RR to（19.3±9.1） ms/RR, P〈0. 001] and TO decreased [from （-0. 76×10 ^-2 ±0.38×10^-2） % to（ 2.13×10^- 2± 0.37 × 10 ^-2 ） % , P〈0.01] in patients with TIMI 3 flow, whereas there were no significant alterations of TS and TO （P〈0.05 all） in patients with TIMI 2 flow. The linear regression analysis between two groups show. that there were negative correlation among TS and the degree of coronary lesions （r= -0.62, P〈0.01）, coronary artery disease score （r= -0. 527, P〈0.05）. The TS was significant reduced in more than 50 percent coronary lesions group （P〈 0.01 ）, also in multivessel coronary artery disease group （P〈0.05） and in group of the coronary severity scores higher than 10. Conclusion： The HRT significantly reduced in CHD patients and significantly reflected the severity of the CHD, The HRT significantly improved in patients with TIMI 3 flow after PCI.