窦性心率震荡对心力衰竭预后的评价

Heart Rate Turbulence and Clinical Prognosis in Chronic Heart Failure

目的探讨窦性心率振荡(HRT)在心力衰竭预后中的预测价值。方法选择41例充血性心力衰竭(CHF)者和正常组进行24h动态心电图(DCG)监测和心脏超声检查,对左室射血分数(LVEF)、左室舒张末期内径(LVDD)、HRT、心率变异性(HRV)、Q-T间期离散度(QTd)进行对比,评估HRT对CHF预后的预测价值。结果死亡组与CHF无恶化组比TO明显增高(-0.02±1.15,-1.24±2.0;P<0.05)、TS明显降低(1.22±0.92,3.81±1.62;P<0.05)。发生室性心动过速/心室颤动组和未发生组TO、TS无统计学差异。在HRT、LVEF和HRV指标相关性分析中,TS与LVEF有相关性(P<0.05),与SDNN、HF呈显著相关性(P<0.01)。单变量Cox回归分析结果显示TO和TS相结合、LVEF、TS、TO四个指标对CHF死亡的预测有显著的意义(P<0.05),多变量Cox回归分析结果显示TO和TS相结合对CHF死亡的预测有最显著的意义(P<0.01)。结论在CHF者中,TS不仅对CHF死亡有预测价值,对CHF恶化也有预测能力。作为CHF预测指标,TO和TS相结合的预测价值远远高于LVEF,但对严重室性心律失常发生无预测价值。

Objective To evaluate the prognostic significance of Heart Rate Turbulence（HRT） in chronic heart failure（CHF） patients. Methods 41 CHF patients and 20 patients without obvious heart diseases（control） waere measured using digitized 24h-Holter ECG recordings.LVEF、LVDD、HRT、HRV、QTd were compared in order to evaluate predictive values of HRT in CHF. Results The value of the HRT onset in patients with CHF death was significantly higher than that in control patients（-0.02±1.15,-1.24±2.0;P〈0.05）.The value of the HRT slope was significantly lower in CHF death than in control（1.22±0.92,3.81±1.62;P〈0.05）.The HRT slope and onset in CHF patients with VT were nearly identical to those without VT.As to the correlations between HRT,LVEF,and HRV in the CHF patients,the HRT slope was significantly correlated with the LVEF（P〈0.05）,SDNN（P〈0.01）,and HF（P〈0.01）.Single Cox-regression analysis revealed that TO and TS,LVEF,TS,TO were the statistically significant predictors of CHF death（P〈0.05）.Multivariate Cox-regression analysis revealed that TO and TS was a stronger predictors of CHF death than others（P〈0.01）. Conclusion The HRT slope appears to be a powerful prognostic marker of CHF death and CHF hospitalization.As prognostic markers,TO and TS are stronger predictors of CHF than LVEF.However,it has limited value for predicting fatal ventricular arrhythmias.