动态心率震荡与慢性心衰预后指标的相关性

Changes of turbulence dynamics in patients with chronic heart failure and its correlation with traditional prognostic indices

目的观察心率震荡(HRT)的新指标-动态心率震荡(TD)在慢性心力衰竭患者中的变化及HRT各指标与传统高危预测指标的相关性。方法选择55例慢性心衰患者(心衰组)和32例非器质性心脏病患者(对照组)接受24h动态心电图检查,分别计算HRT的震荡初始(TO)、震荡斜率(TS)、动态心率震荡(TD)及心率变异性时域指标SDNN、平均心率及左室射血分数(LVEF),比较心衰组与对照组HRT各指标的差异,及其与传统高危预测指标的相关性。结果心衰组TO明显高于对照组,TS和TD低于对照组(p<0.05);心衰组各指标相关性分析结果显示,年龄和平均心率与TO正相关,与TS负相关;TO与SDNN、LVEF呈负相关,TS与SDNN、LVEF呈正相关(p<0.05);TO与TS负相关(p=0.004);TD与平均心率、SDNN、LVEF均无显著相关性(p>0.05)。结论心衰组HRT明显减弱,尤以TD和TS变化显著;新指标TD在测量时不受平均心率等因素影响,提示与TO、TS相比,TD可提供更客观预测价值,HRT可作为慢性心衰患者预后评估又一项新的高效预测指标。

Objective To explore the change of turbulence dynamics（TD） and its correlation with traditional prognostic indices of HRT in patients with chronic heart failure（CHF）.Methods Fifty-five patients with CHF（CHF group） and thirty-two patients with non-organic heart disease（control group） were chosen.Turbulence onset（TO）、turbulence slope（TS）、Turbulence dynamics（TD） and heart rate variability（HRV）,mean heart rate and left ventricular ejection fraction（LVEF） were determined by 24h digitized Holter recordings and ultrasonic cardiogram（UCG）.The value of these indices were compared between CHF group and control group.The correlation of HRT with traditional prognostic indexes was analyzed.Results The value of the TO was significantly higher in CHF group than in control group,The value of the TS and TD was significantly lower in CHF group than in control group（p〈0.05）;TO was positively correlated with age and mean heart rate,TS was negatively correlated with age and mean heart rate,TS was positively correlated with SDNN and LVEF,TO was negatively correlated with SDNN and LVEF（p〈0.05） and TO was negatively correlated with TS（p=0.004）.But TD was not corrected with mean heart rate,SDNN and LVEF（p〉0.05）.Conclusion The results indicate that HRT was significantly blunted in CHF patients,TD may be a more objective index for predicting CHF than TO and TS.HRT could serve as a new and strong predictor for high-risk CHF patients.