非ST段抬高急性冠脉综合征患者心率震荡的变化

Study on changes of heart rate turbulence in NSTE-ACS patients and influence of PCI

目的 探讨非ST段抬高急性冠脉综合征（NSTE-ACS）患者的GRACE评分、冠脉病变程度与心率震荡各指标之间的关系.方法 选择NSTE-ACS患者64例,定为NSTE-ACS组;同时选取71名健康者作为对照组.将NSTE-ACS组根据GRACE评分系统分为极高危组（24例）、高危组（21例）和低危组（19例）;根据冠状动脉病变累及范围分为左主干病变组（7例）、单支血管病变组（26例）、双支血管病变组（21例）和三支血管病变组（10例）;将冠脉造影结果按SYNTAX评分,分为高积分组（9例）、中积分组（25例）和低积分组（30例）.所有入选者行24h动态心电图检查,计算震荡初始值（TO）和震荡斜率（TS）,进行统计分析.结果 ①NSTE-ACS组TO明显高于对照组,TS明显低于对照组,两值比较差异均有统计学意义（P＜0.01）.②NSTE-ACS组中GRACE评分极高危组、高危组、低危组各组TO、TS值比较差异均有统计学意义（P＜0.01）.③单支病变组、双支病变组及左主干病变组TO值比较差异无统计学意义;三支病变组TO值明显升高,差异有统计学意义（P＜0.05）.TS值各组间比较差异均有统计学意义（P＜0.05）.④SYNTAX评分高积分组、中积分组、低积分组各组TO、TS值比较差异均有统计学意义（P＜0.05）.结论 NSTE-ACS患者心率震荡减弱;GRACE评分越高,心率震荡减弱越严重;心率震荡与冠状动脉病变程度明显相关,冠状动脉病变累及支数越多,SYNTAX评分越高,心率震荡减弱越严重.

Objective To study the relationship of HRT with severity of coronary artery lesions in NSTEACS patients,and the effect of PCI on HRT.Methods We selected 64 NSTE-ACS patients undergoingt coronary angiography （CAG）.Meanwhile,71 healthy cases were selected as control group who were confirmed by CAG to exclude coronary heart disease.According to the severity of coronary artery lesions,the NSTE-ACS group was divided to left main lesion group（n=7）,single-vessel group（n=26）,bi-vessel group（n=21） and poly-vessel group （n=10）.In addition,according to the GRACE scoring system,the NSTE-ACS group were divided into very-high risk group（24 cases）,high-risk group （21 cases） and low-risk group （19 cases）.SYNTAX score was calculated according the vessel lesions,and then NSTE-ACS patients were divided into high score group （9 cases）,mediate score group （25 cases）,low score group （30 cases）.All the cases were performed Holter.Turbulence onset（TO）and turbulence slope （TS） were calculated.Results （1）TO value in NSTE-ACS group were higher than the controls.TS value was significantly lower than that of the controls.The difference was statistically significant （P〈0.01）.（2）TO value was higher and TS was lower in the very high-risk group compared to those in high-risk group and lowrisk group（P〈0.01）.（3）TO value have no difference among different vessel-lesion groups,but significantly increased in poly-vessel group （P〈0.05）.TS value was statistically significant （P〈0.05） in each group.（4）TO values rised and TS reduced successively among high score group,mediate score group and low product group.Conclusion Heart rate turbulence is attenuated in patients with NSTE-ACS.HRT has a negative correlation with the severity of coronary artery disease,GRACE score and the SYNTAX score.The HRT parameters may be improved by PCI.