窦性心率震荡检测对缺血性心肌病的预后判断

Heart rate turbulence as a predictor of cardiac mortality in patients with ischemic cardiomyopathy

目的分析心率震荡(HRT)对包括缺血性心肌病患者发生心源性猝死的预测价值。方法从2008年1～2009年6月就诊的缺血性心肌病患者(ICM)患者中选取符合窦性心率震荡(HRT)分析条件的85名患者,健康对照组31人。根据24h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),HRT1组,TO和TS均异常即TO>0%和TS<2.5ms/RR。HRT0组,TO或TS1项异常;终点事件是心源性死亡发生。结果 HRT异常占入选病人总数的28.2%,在445±126的随访时间,11个人死亡,HRT1与年龄、LVEF、TO、TS呈相关性。HRT异常与缺血心肌病患者的死亡率均密切相关。结论 HRT指标与年龄,LVEF等指标有较好的相关性,可作为ICM患者预后指标之一。

Objective To prospectively assessed the utility of HRT for risk stratification in patients with ischemic or nonischemic ICM. Methods We enrolled 85 consecutive patients with ICM,65 people with controls. HRT was measured using an algorithm based on routine 24-hour Holter electrocardiograms,assessing 2 parameters：turbulence onset （TO） and turbulence slope （TS）. HRT1 was considered positive when both TO was ≥0% and TS was ≤ 2.5 ms/RR interval. HRT0 was considered positive when TO was ≥0% or TS was ≤ 2.5 ms/RR interval. The primary endpoint was defined as cardiac mortality. Results Twenty-three of 85 patienTS （28.2%） were HRT-positive. During follow-up of 445 ± 126 days,11 patients （12.9%） reached the primary endpoint. There was a significant correlation between HRT positivity and LVEF,old in ICM patients. On subanalysis,HRT positivity was significantly associated in both ICM patients with both the primary endpoint. Conclusions HRT is a powerful risk stratification marker for cardiac mortality in patients with ICM.