心率变异性、QT离散度及心室晚电位对慢性心衰患者预后的判断价值

THE PROGNOSTIC VALUE OF HEART RATE VARIABILITY,QT DISPERSION ANDVENTRICULAR LATE POTENTIAL IN CONGESTIVE HEART FAILURE

目的评价心率变异性（ＨＲＶ）、ＱＴ离散度（ＱＴｃｄ）和心室晚电位（ＶＬＰ）对慢性心衰患者预后的判断价值。方法对４２例慢性充血性心力衰竭患者及３７例正常人分别进行ＨＲＶ、ＱＴｃｄ以及ＶＬＰ联合测定，观察上述诸值的变化与心衰程度及心脏事件（恶性心律失常或猝死）的关系。结果慢性心衰患者的ＨＲＶ较对照组明显减少（Ｐ＜０．０１），ＱＴｃｄ明显延长（Ｐ＜０．０１），ＶＬＰ阳性率明显增高（Ｐ＜０．０１）。心衰程度越重，上述诸值的变化越显著（Ｐ＜０．０５，Ｐ＜０．０１）。心衰组中，２５例发生心脏事件者与１７例非心脏事件者比较，ＨＲＶ、ＱＴｃｄ及ＶＬＰ阳性率的变化均有显著差异（Ｐ＜０．０１）。其中，敏感性最高的是２４ｈ正常ＲＲ间期标准差（ＳＤＮＮ），特异性与阳性预测值最高的是ＶＬＰ，有效性最高的是ＱＴｃｄ。３项指标组合后综合分析，则随着异常项目的增加，其特异性、有效性、阳性预测值及相对危险性均更高。结论ＨＲＶ、ＱＴｃｄ及ＶＬＰ对慢性心衰患者的预后均有较高的预测价值。若同时测定，综合分析，其预测价值更高、更可靠。

Objective To evaluate the value of heart rate variability (HRV)QT dispersion (QTcd)and ventricular late potential (VLP) in predicting the outcome of congestive heart failure (CHF). MethodsT5BZThe 3 indices in 42 CHF patients were determined and compared with that of 37 normal subjects to unveil the relationship between the changes and the degree of CHF and cardiac events (i.e.pernicious cardiac arrhythmia or sudden death). Results The CHF group showed marked decrease of HRV (P<0.01),prolonged QTcd (P<0.01) and increased rate of VLP positivity(P<0.01). These changes were found proportional to the degree of CHF(P<0.05,P<0.01). Comparison of the data between the 25 patients with cardiac events and the 17 patients without cardiac events revealed significant differences in all of the 3 indices, with the SDNN (of HRV) being the most sensitive,VLP the most specific with highest positive predictive value, and QTcd the most efficient. Conclusion HRV, QTcd and VLP are all of high prognostic value to CHF patients.Simultaneous determination of the indices and comprehensive consideration of the data will enhance the accuracy and reliability of the prognosis or the risk of cardiac events.