心率变异指数对老年高血压患者心脏事件的预测价值

The prodictive value of the heart rate variability index on the cardiac accidents in the elderly hypertensive patients

目的：了解心率变异指数（ＨＲＶＩ）对老年高血压心脏事件的预测价值。方法：２３１例老年（≥６０岁）高血压患者经超声心动图和２４ｈ动态心电图测定心率变异指数（ＨＲＶＩ）、左室质量指数（ＬＶＭＩ）及左室射血分数（ＬＶＥＦ），并通过多元回归分析评估在为期２年的随访期中ＨＲＶＩ对患者的心脏事件（心肌梗死、心力衰竭、心脏停搏）的预测价值。结果：ＨＲＶＩ减低的发生率及ＨＲＶＩ平均值在左室肥厚组（ＬＶＨ）为６１．９％，１９．８±９．４；无ＬＶＨ组为２９．５％，２２．４±７．１（Ｐ＜０．０５）；在ＬＶＥＦ＜５０％组为６４．２％，１８．８±８．５，ＬＶＥＦ≥５０％组为３１．５％，２２．７±１１．１（Ｐ＜０．００１）；在有心脏事件组为９７．８％，１７．３±８．２，无心脏事件组为３３．０％，２３．４±７．９（Ｐ＜０．００１）。多元回归分析结果显示，对老年高血压患者心脏事件的预测价值ＨＲＶＩ最高（ｒ＝０．６４５３，Ｐ＝０．０００１），其次是ＬＶＥＦ（ｒ＝－０．４９８３，Ｐ＝０．００２８），ＬＶＭＩ（ｒ＝０．３８７９，Ｐ＝０．００２４）和年龄（ｒ＝０．２８４５，Ｐ＝０．０００１）。结论：ＨＲＶＩ减低作为独立的危险因素，对老年高血压患者?

Objective:To investigate the prodictive value (PV) of the heart ratevariability index (HRVI) for the cardiac accident (CA) in the elderly hypertensive patients.Methods:231 hypertensive patients (≥60 years) were examined by Holter ECG and UCG to determine HRVI, left ventricular mass index (LVMI) and left ventricular ejection fraction (LVEF). The PV of those parameters above for the CA was analyzed by Logistic multiple regression method after the period of two year follow up. Results:The incidence of decreased HRVI (≤25) and mean HRVI were 61.9% and 19.8±9.4 in LVH group (LVMI≥134 g/m 2 in male, ≥110 g/m 2 in female); 29.5% and 22.4±7.1 in NLVH group ( P <0.05);64.2% and 18.8±8.5 in LVEF<50% group; 31.5% and 22.7±11.1 in LVEF≥50% group ( P <0.001); 97.8% and 17.3±8.2 in CA group, 33.0% and 23.4±7.9 in NCA group ( P <0.001) respectively. The results of logistic analysis in these patients showed that the PV of HRVI was highest among those parameters ( r =-0.6453, P =0.0001),then were LVEF ( r =-0.4983, P =0.0028), LVMI ( r =0.3879, P =0.0024) and age ( r =0.2845, P =0.0001). Conclusion:The decrease of HRVI as an independent risk factor has very important PV for CA in the elderly hypertensive patients.