扩张型心肌病患者窦性心率震荡现象的临床研究

Study of heart rate turbulence in patients with dilated cardiomyopathy

目的探讨心电学指标-窦性心率震荡（HRT）在扩张型心肌病（DCM）患者中的变化，以及与心率变异性时阈指标（SDNN）、左室射血分数（LVEF）、左室舒张末期内径（LVEDD）的关系，从而探讨其对心源性猝死的预测价值。方法选择扩张型心肌病患者22例，正常健康体检者（对照组）22例，根据24小时动态心电图（Holter）记录资料，计算HRT的两个参数：震荡初始（TO）和震荡斜率（TS），比较两组间的差异，并计算TO、TS与SDNN、LVEF、LVEDD之间的相关性。结果DCM组TO值显著高于对照组（3．384±5．45）％VS（-6．08±3．76）％，P〈0．05；DCM组TS值显著低于对照组（5．76±5．33）ms／RR间期VS（12．68±5．84）ms／RR间期，P〈0．05。DCM患者中TO与SDNN、LVEF、LVEDD间有明显相关性。结论DCM患者室性早搏后的HRT现象减弱，HRT可能成为评价DCM患者自主神经功能状态的一个新指标，可用来预测DCM患者心源性猝死的风险。

Objective To study the change of heart rate turbulence（HRT） in dilated cardiomy- opathy and its relationship with standard deviation of mormal-to-mormal RR interals （SDNN）, left ventrieular ejection fraction（LVEF） and left ventricular end-diastolic diameter（LVEDD）. Methods 22 patients with dilated cardiomyopathy（DCM） and 22 control subjects were investigated. HRT onset and solpe were measured by the original definitions suing Hoher records and analysed its relevance with SDNN,LVEF and LVEDD. Results The value of the HRT onset was significantly higher in DCM group than that in control group （ 3. 384 ± 5.45 ） % vs （ - 6.08 ± 3.76 ） %, P 〈 0.05 ; the value of the HRT slope in DCM group was significantly lower than that in control group（5.76 ± 5.33 ）ms/RR interval vs （12.68 ±5.84）ms/RR interval ,P 〈 0.05. There was a significant correlation between TO and SDNN ,LVEF^LVEDD in DCM patients. Conclusion Heart rate turbulence is dramatically blunted in DCM patients and maybe become a new pre- dictor of the cardiac autonomic status risk of sudden cardiac death in DCM patients.