老年稳定性心绞痛患者窦性心率震荡的临床意义

Clinical significance of sinus heart rate turbulence in elderly patients with stable angina pectoris

目的探讨老年稳定性心绞痛(SAP)患者窦性心率震荡(HRT)现象的临床意义。方法选择接受24 h动态心电图检查的老年患者137例为SAP组,另选冠状动脉造影正常的老年患者155例为对照组。分析其动态心电图,测量HRT的起始值(TO)和震荡斜率(TS)。比较各组TO与TS的差异。结果对照组TO较SAP组明显降低(0.78±1.60vs 1.25±1.87,P<0.05),TS明显升高(5.44±4.12vs 1.51±0.69,P<0.01)。与对照组比较,SAP组TO、TS及TO+TS异常率明显升高(P<0.05,P<0.01)。对照组TS与年龄呈正相关(r=0.35,P<0.01);SAP组TS与LVEF呈负相关(r=-0.29,P<0.01)。结论老年SAP患者冠状动脉有严重狭窄者应积极行完全血运重建,HRT可作为SAP患者的风险预测因素,为其治疗策略和预后提供有意义的临床依据。

Objective To study the clinical significance of sinus heart rate turbulence（ HRT） in eld erly patients with stable angina pectoris（SAP）. Methods One hundred and thirty-seven patients under dynamic electrocardiographic monitoring served as a SAP group and 155 patients with nor- mal coronary arteriogram served as a control group. The turbulence onset（TO） and turbulence slope（TS） of sinus HRT on dynamic electrocardiogram were analyzed and their difference was compared between different groups. Results The TO was significantly lower while the TS was significantly higher in control group than in SAP group （0.78＋1.60 vs 1.25 ＋ 1.87, Pal0.05; 5.44＋4.12 vs 1.51＋0.69 ,P（0.01）. The TO,TS and TO＋TS were significantly higher in SAP group than in control group（P〈0.05,P〈0.01）. The TS was positively related with the age in control group（r= 0. 35, P〈0. 01） and negatively related with the LVEF in SAP group （r = --0.29,P〈0.01）. Conclusion Complete blood supply should be reconstructed for severe coronary artery stenosis in elderly SAP patients. Sinus HRT can be used as a risk predictor of SAP patients,thus providing certain significant clinical clues for its treatment strategies and prognosis.