心衰患者HRT与6分钟步行试验的相关性

Correlations of heart rate turbulence and 6-minute walk test cardiac function in elderly patients with chronic heart failure

目的探讨老年慢性心力衰竭（CHF）患者窦性心率震荡（HRT）与心功能、运动耐量的相关性。方法 42例心衰患者（心衰组）,30例健康对照组。CHF组根据HRT组成不同分为：HRT0组、HRT1组、HRT2组。比较CHF组和健康对照组及CHF各亚组间HRT指标[震荡初始（TO）、震荡斜率（TS）]差异,进一步分析HRT与6分钟步行试验（6-MWT）,左心室射血分数（LVEF）,左室舒张末期内径（LVDED）等因素的相关性并通过随访6~12月心血管事件的发生率分为高危组,低危组进行组间比较。结果心衰组TO,LVDED明显高于对照组（0.04±0.018vs.-0.02±0.011;60.36±8.25vs.42.84±6.43p〈0.05）,TS,6-MWT,LVEF明显低于对照组（9.63±5.14vs.18.12±6.56;207.13±46.12vs.415.50±62.19;39.58±9.76vs.62.17±5.32〈0.05）。高危组中HRT现象亦比低危组明显减弱。心衰组6-MWT与LVDED,TO呈负相关,与LVEF,TS呈正相关。结论在慢性心衰患者中监测HRT和6分钟步行试验,动态评估心衰进展,可以采取相应的社区干预模式,尤其适合于基层医院制定最佳治疗方案。

Objective To investigative the correlations of heart rate turbulence （HRT） and 6-minute walk test （6-MWT） in orderly patients with chronic heart failure （CHF）. Methods forty-two cases of elderly patients with CHF, 30 healthy control group. In patients with CHF were divided into three groups according to HRT, HRTO, HRT1, HRT2. The following tests were performed： 6-minute walk test, mean heart rate Turbulence onset（TO） and turbulence slope （TS） were calcnlated from 24-hour Holter records. Left ventricular ejection fraction （LVEF） and left ventricular end dilatation diameter （LVDED） were measured by Ultrasonic Cardiograph. Results The heart failure group TO as well as the LVDED value obviously is higher than the comparison group（O.04 ± 0.018 vs. -0.02 ±0.011; 60.36 ± 8.25 vs. 42.84 ±6.43 p〈O.05）. TS as well as the 6-MWT and LVEF value obviously is lower than the comparison group （9.63 ± 5.14 vs. 18.12 ± 6.56; 207.13 ± 46.12 vs. 415.50 ± 62.19; 39.58 ± 9.76 vs. 62.17 ± 5.32 p〈0.05）. In heart failure group, there was positive correlation between TS and 6-MWT and negative correlation between TO and 6-MWT. HRT2 was the strongest predictor and showed prognostic value to the primary end point in elderly patients with CHF. Conclusion HRT are associated with the heart function and 6-MWT of CHF. Intensively HRT, 6-MWT and suitable therapy strategy may help to attenuate the cardiac remodeling in patients with CHF.