老年稳定型心绞痛患者窦性心率震荡现象的临床意义

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

目的:探讨老年稳定型心绞痛(SAP)患者窦性心率震荡(HRT)现象的临床意义。方法:选择2013年1月~2015年10月于本院进行24h动态心电图检查的120例老年SAP患者作为SAP组,另选择同期行24h动态心电图且冠状动脉造影检查正常的144例老年患者作为正常对照组。根据冠脉病变程度,SAP组被进一步分为单支病变组(35例)、双支病变组(48例)和多支病变组(37例)。测量比较各组24h动态心电图,HRT指标[震荡初始(TO)、震荡斜率(TS)]。结果:与正常对照组比较,SAP组TO[(0.77±0.37)%比(1.26±0.92)%]显著升高,TS[(5.45±4.02)ms/RR间期比(1.53±0.70)ms/RR间期]显著降低,P均<0.01;TO异常率(19.44%比42.50%)、TS异常率(15.97%比31.67%)和TO+TS异常率(11.11%比30.83%)均显著升高,P均<0.01。与单支病变组比较,双支病变组和多支病变组TO[(0.66±0.22)%比(1.28±1.11)%比(1.46±1.20)%]显著升高,TS[(2.04±0.82)ms/RR间期比(1.66±0.38)ms/RR间期比(1.29±0.58)ms/RR间期]显著降低,且多支病变组TO显著高于双支病变组,TS显著低于双支病变组,P均<0.01。结论:窦性心率震荡现象可作为老年稳定型心绞痛患者风险预测因素,为其临床有效治疗和预后评估提供参考。

Objective.. To explore clinical significance of sinus heart rate turbulence （HRT） phenomenon in aged patients with stable angina pectoris （SAP）. Methods： A total of 120 aged SAP patients, who received 24h DCG in our hospital from Jan 2013 to Oct 2015, were selected as SAP group. Meanwhile, another 144 aged patients, who received 24h DCG examination simultaneously and coronary angiography results were normal, were regarded as normal control group. According to coronary lesion severity, SAP group was further divided into single vessel coronary disease group （single vessel group, n = 35）, double-vessel coronary disease group （double-vessel group, n = 48） and multi-vessel coronary disease group （multi-vessel group, n = 37）. The 24h DCG, HRT indexes, including turbulence onset （TO） and turbulence slope （TS）, were measured and compared among all groups. Results： Compared with normal control group, there was significant rise in TO [-（0.77 ± 0.37）% vs. （1.26 ± 0.92）%] and significant reduction in TS [ （5.45 ±4.02） ms/RR interval vs. （1.53 ± 0.70） ms/RR interval], P〈0.01 both; significant rise in abnormal rates of TO （19.44% vs. 42.50%）, TS （15.97% vs. 31.67%） and TO ＋ TS （11.11% vs. 30.83%） in SAP group, P〈0.01 all. Compared with single vessel group, there was significant rise in TO [ （0.66 ± 0.22） % vs. （1.28 ± 1.11） % vs. （1.46 ± 1.20） %] and significant reduction in TS [ （2.04 ± 0.82） ms/RR interval vs. （1.66 ±0.38） ms/RR interval vs. （1.29 ±0.58） ms/RR interval] in double-vessel group and multi-vessel group, and TO of multivessel group was significantly higher than that of double-vessel group, TS of multi-vessel group was significantly lower than that of double-vessel group, P〈0.01 all. Conclusion： Sinus heart rate turbulence can be used as risk predictor for aged patients with stable angina pectoris, which can provide basis for clinical effective treatment and prognosis assessment.