短时非线性心率变异性对心力衰竭患者心功能的评价

Short-term heart rate variability in assessing cardiac status of heart failure patients

目的评价短时非线性的心率变异性指标在不同心功能分级的慢性心力衰竭患者中的变化及影响因素。方法应用5 min动态心电图分析84例慢性心力衰竭患者的心率变异性(HRV),非线性指标包括滑动窗口测度熵(MwEn)、中心边缘比(CER)、累积能量(CE),线性指标包括极低频功率(VLF)、低频功率(LF)、高频功率(HF)、低频功率/高频功率(LF/HF)、总功率(TP)、低频功率的标化值(LFn)、高频功率的标化值(HFn);用彩色多普勒超声诊断仪测定左室射血分数(LVEF)。将心率变异性指标与41例健康者进行比较,并分析非线性指标的影响因素。结果短时非线性心率变异性指标在不同心功能分级组间的差异存在统计学意义(P<0.05),在年龄、心率及LVEF三项指标中,LVEF是影响MwEn(r=0.50,P<0.001)、CER(r=-0.27,P=0.007)、CE(r=-0.30,P=0.003)的主要因素。结论短时非线性心率变异性分析可用来评价慢性心力衰竭患者的心功能状态,且与线性指标相比,具有较强敏感性。

Objectives To investigate the differences of short-term nonlinear heart rate variability（HRV）parameters among the groups of various cardiac functional classes and determine the influencing factors.Methods Parameters,including measure slide-window entropy（MwEn）,center-edge ratio（CER）,cumulative energy（CE） and frequency-domain analysis,were analyzed with 5-minute dynamic electrocardiography,while the left ventricular ejection fraction（LVEF） was measured by echocardiogram in both 84 patients and 41 healthy controls.HRV parameters among the different cardiac functional classes and influencing factors of nonlinear parameters were analyzed.Results There were significant differences in nonlinear HRV parameters among the different cardiac functional classes（P0.05） and LVEF,but neither age nor heart rate,was the chief factor that influenced MwEn（r=0.50,P0.001）,CER（r=-0.27,P=0.007） and CE（r=-0.30,P=0.003）.Conclusions Short-term nonlinear HRV analysis can be used to evaluate the cardiac status of patients with chronic heart failure and compared with linear indexes,it is more sensitive.