左室射血分数保留的心力衰竭患者心脏变时性及心率恢复研究

Study of heart rate recovery and chronotropic response in heart failure patients with preserved ejection fraction

目的探讨左室射血分数保留的心力衰竭(HFPEF)患者运动负荷试验时心率变时性(Chronotropic Response,CR)及心率恢复(Heart Rate Recovery,HRR)变化及意义。方法选取46例HFPEF患者及28正常对照,均常规行多普勒超声检测左心室舒张功能及心电图运动负荷试验,记录静息心率、峰值心率及运动后3 min内的心率,计算心率储备百分率(percentage of HR reserve)、峰值心率百分比(percentage of peak HR)及运动后第1,2,3 min的HRR(HRR1,HRR2,HRR3),比较两组间CR及HRR指标的关系。结果 (1)HFPEF组与正常对照组比较,二尖瓣口血流频谱舒张晚期峰速(A峰)、二尖瓣口血流频谱舒张早期峰速和二尖瓣环运动频谱舒张早期峰速比(E峰/Em)、等容舒张时间(IVRT)升高(0.93±0.13 vs 0.68±0.12,9.68±1.89 vs 7.17±1.33,89.65±16.90 vs77.04±7.53),差异均有统计学意义(P<0.01);而二尖瓣口血流频谱舒张早期和舒张晚期峰值比(E峰/A峰)、二尖瓣环运动频谱舒张早期峰速(Em)、二尖瓣环运动频谱舒张早期峰速和二尖瓣环运动频谱舒张晚期峰速比(Em/Am)下降(0.89±0.13 vs 1.20±0.15,8.69±1.3 vs 11.53±1.88,0.86±0.31 vs 1.23±0.37),差异均有统计学意义(P<0.01)。(2)HFPEF组峰值心率,心率储备显著减低;以心率储备百分率及峰值心率百分比表示的CR功能显著减低;HFPEF组运动停止后前3min时的心率恢复显著减低,HFPEF组的METs低于对照组(P<0.01)。结论 HFPEF患者CR及HRR较正常人减低,提示存在心脏自主神经功能异常。

Objective To investigate the changes in Heart Rate Recovery（ HRR） and Chronotropic Response（ CR） after maximal exercise treadmill testing in heart failure patients with preserved ejection fraction（ HFPEF） and its significance. Methods 46 patients with HFPEF and 28 normal subjects were enrolled. All patients and the control group were submitted color Doppler echocardiography,evaluated the main index of left ventricular diastolic function. Treadmill exercise testing was performed in all of them. Heart Rate（ HR） was measured at rest,at maximum exercise and at 1,2,and 3 minutes into recovery,percentage of HR reserve,percentage of peak HR and HR recovery 1,2,3- minute after exercise were calculated. Results HFPEF group compared with the normal control group,late diastolic mitral flow velocity peak（ A peak）,early diastolic mitral flow velocity and mitral annulus peak early diastolic peak velocity spectrum（ E peak / Em）,isovolumic relaxation time（ IVRT） increased（ 0. 93 ± 0. 13 vs 0. 68 ± 0. 12,9. 68 ± 1. 89 vs 7. 17 ± 1. 33,89. 65 ± 16. 90 vs 77. 04 ±7. 53）,the differences were statistically significant（ P〈0. 01）. And the diastole early and late diastolic peak ratio（ E peak / A）,early diastolic mitral annular motion spectrum peak velocity（ Em）,early diastolic mitral annulus annulus peak velocity spectrum and late diastolic peak velocity of mitral spectrum（ Em / Am） decreased（ 0. 89 ± 0. 13 vs 1. 20 ± 0. 15,8. 69 ± 1. 3 vs 11. 53 ± 1. 88,0. 86 ± 0. 31 vs 1. 23 ± 0. 37）,the differences were statistically significant（ P〈0. 01）. Peak heart rate and heart rate reserve decreased significantly in HFPEF group. CR functions significantly decreased; Heart rate recovery significantly reduced at the first 3 min after exercise stop in HFPEF group. Met S of HFPEF group was lower than that in control group（ P〈0. 01）.Conclusions Patients with HFPEF have impaired HHR and CR,these patients could have early abnormal modulation of cardiac autonomic activity.