窦性心率震荡对老年人慢性心功能不全预后的预测价值

Prognostic value of heart rate turbulence in patients with chronic heart failure

目的探讨窦性心率震荡（HRT）对老年慢性心功能不全（CHF）患者预后的预测价值。方法选择本院2006年10月至2009年5月住院的老年CHF患者96例，记录其相关临床资料，并进行超声心动图、动态心电图检查。应用相应的分析软件对动态心电图检查结果进行分析，比较不同心功能分级患者窦性HRT指标变化的差异；随访9～28个月，终点事件为患者心源性死亡，采用Logisitc回归法分析窦性HRT、年龄、高血压、糖尿病、心肌梗死、左室射血分数（LVEF）、血管紧张素转换酶抑制剂（ACEI）、B受体阻滞剂对CHF患者死亡的预测能力。结果按照震荡初始和震荡斜率结果进行HRT分类，HRT的主要参数正常在心功能Ⅱ级（60．0％）与Ⅲ级（45．0％）者比较差异无统计学意义（x2=1．60，P〉0．05）；心功能Ⅲ级与Ⅳ级者（16．7％）比较差异无统计学意义（x2=1．43，P〉0．05）；但心功能Ⅱ级与Ⅳ级者比较差异有统计学意义（x2=9．84，P〈0．05），HRT在心功能Ⅳ级组明显减弱。平均随访（18．0±9．6）个月，96例患者中，心源性死亡34例，分析显示CHF患者死亡与HRT、低LVEF（≤45％）、年龄（≥65岁）、糖尿病、心肌梗死及心功能分级相关。结论窦性HRT指标对老年人CHF预后有良好的预测能力。

Objective To investigate the prognostic value of heart rate turbulence （HRT） in patients with chronic heart failure （CHF）. Methods From October 2006 to May 2009, a total of 96 elderly CHF inpatients were selected, and the clinic data were recorded. Based on the echocardiogram and dynamic electrocardiogram, the differences of sinus HRT index of patients with different cardiac function classification were analyzed. During 9-28 months medical follow up, the treatment endpoint was death from heart disease. Based on Logisitc regression, the prognostic values of HRT, age, hypertension, diabetes, myocardial infarction （MI）, left ventricular ejection fraction, ACEI and β- adrenergic blocker for death of CHF patients were analyzed. Results There was no significant difference in HRT between grade Ⅱ and grade Ⅲ cardiac function （X2 = 1.60, P） 0.05）, and between grade Ⅲ and grade Ⅳ cardiac function （x2= 1.43, P〉0.05）. But there was significant difference in HRT between grade Ⅱ and grade Ⅳ cardiac function patients 2 =9.84, P〈0.05）, and HRT was weaken in grade IV group. The average follow up time was （18.0±9.6） months. Of all 96 patients, there were 34 dead of heart disease. There were correlations of death of CHF with HRT, lowLVEF （≤45%）, age （≥65 years）, diabetes, MI and classification of heart function. Conclusions The sinus HRT in CHF patients has a favorable prognostic value.