慢性心力衰竭患者心率震荡起始时间分析

Study of Heart Rate Turbulence Timing in Patients with Chronic Heart Failure

目的:研究窦性心率震荡(HRT)的新测量指标震荡斜率起始时间(TT)及HRT测量指标震荡初始(TO)、震荡斜率(TS)在慢性心力衰竭(CHF)患者中的变化,并分析各指标与年龄、室性早搏前心率、联律间期、代偿间期及左房内径(LAD)、左心室舒张末期内径(LVEDD)、左室射血分数(LVEF)之间的相关性。方法:选择79例慢性心力衰竭患者作为CHF组,51例非心脏病患者作为对照组,所有研究对象均经超声心动图测量LAD、LVEDD、LVEF值,同时行动态心电图检查,计算HRT的3个指标:TO、TS、TT,及室性早搏前心率、联律间期、代偿间期。比较CHF组与对照组各指标的差异,并分析HRT各指标与其他指标的相关性。结果:CHF组TT、TO、LAD、LVEDD显著高于对照组,TS、LVEF显著低于对照组。CHF组TO与TS呈负相关(P=0.028),与LVEF呈负相关(P=0.023),TS与室性早搏前心率呈负相关(P=0.002),与室性早搏联律间期(P=0.008)及代偿间期呈正相关(P=0.024);对照组TO与年龄呈正相关(P=0.009),与联律间期呈正相关(P=0.049),TS与室性早搏前心率呈负相关(P=0.006),与代偿间期呈正相关(P=0.014);2组TT与其他所有指标间均无显著相关(P>0.05)。结论:CHF患者HRT明显减弱,其中TT值增大提示患者室性早搏后窦性心率减速现象出现时间延迟,TT有望成为更客观的预测指标。

Objective：To investigate the change of heart rate turbulence（HRT）including turbulence timing（TT）,turbulence onset（TO） and turbulence slope（TS） and its correlation with age,heart rate（HR） before ventricular premature complexes（VPCs）,coupling interval,compensatory pause,left atrial dimension（LAD）,left ventricular end-diastolic dimension（LVEDD） and left ventricular ejection fraction（LVEF） in patients with chronic heart failure（CHF）.Methods：A total of 79 patients with chronic heart failure（CHF group） and 51 patients without organic heart disease（control group） were assigned.TO,TS,TT,HR before VPCs,coupling interval,compensatory pause,LAD,LVEDD and LVEF were determined by 24h ambulatory electrocardiograph（Holter） and ultrasonic cardiogram（UCG）.The value of above indexes was compared between two groups.The correlation of HRT with other indexes was analyzed.Results：The levels of TT,TO,LAD,LVEDD in CHF group were significantly higher than those in control group,and TS,LVEF were lower in control group（P0.05）.In CHF group,TO was negatively correlated with TS（P=0.028） and LVEF（P=0.023）,TS was negatively correlated with HR before VPCs（P=0.002）,and was positively correlated with coupling interval（P=0.008） and compensatory pause（P=0.024）.In control group,TO was positively correlated with age（P=0.009） and coupling interval（P=0.049）.TS was negatively correlated with HR before VPCs（P=0.006）and was positively correlated with compensatory pause（P=0.014）.In both two groups.TT was not correlated with all the other indexes（P0.05）.Conclusions：HRT appeares significantly blunted in patients with CHF,TT increasing indicates that the deceleration of HR after VPCs delays.TT may be a more objective index for predicting for high-risk patients.