扩张型心肌病患者心率减速力、连续心率减速力、心率加速力及心率变异性与左室射血分数相关性分析

Correlations among deceleration capacity of heart rate,heart rate deceleration runs,aceleration capacity of heart rate,heart rate variability and left-ventricular ejection fraction in patients with dilated cardiomyopathy

目的本研究拟通过分析扩张型心肌病(dilated cardiomyopathy,DCM)患者心率减速力(deceleration capacity of heart rate,DC)、连续心率减速力(heart rate deceleration run,DRs)、心率加速力(acceleration capacity of heart rate,AC)及心率变异性(heart rate variability,HRV)等指标与左室射血分数(leftventricular ejection fraction,LVEF)的相关性,探讨其在评估自主神经功能受损和预警心源性猝死事件中的价值。方法选取2012年6月至2016年11月本院符合研究标准的DCM患者53例作为DCM组(包括左室射血分数轻度减低者7例,中度减低者12例,重度减低者34例),健康者59例作为对照组,所有受检者行24小时动态心电图检查,计算机自动检测DC、AC、DRs(包括DR1~DR10)及HRV各项指标包括时域指标:RR总体标准差(SDNN)、24小时每5分钟RR间期平均值的标准差(SDANN)、相邻RR间期差值的均方根值(rMSSD)、相邻RR间期差值>50 ms的百分数(pNN50);频域指标:总功率(TP)、极低频功率(vLF)、低频功率(LF)、高频功率(HF)及比值(LF/HF)。DCM组行心脏超声心动图测定左室射血分数。采用统计学分析DC、AC、DRs及HRV各项指标与LVEF的相关性。结果 DCM组与对照组比较,DC、AC、DR1~DR10、SDNN、SDANN、rMSSD、pNN50、TP、vLF、LF、HF差异均有统计学意义(P<0.05);不同左室射血分数组比较,DC、AC、DR1、DR3~DR10、SDNN、SDANN、TP、vLF、LF差异有统计学意义(P<0.05);相关性分析显示DC、DRs(DR2、DR4、DR8)、SDNN、SDANN、TP、vLF、LF与LVEF呈正相关,AC与LVEF呈负相关,具有统计学意义(P<0.05)。结论 DC、DRs、AC、HRV等指标可评估DCM患者自主神经功能受损情况,对心源性猝死有预警价值。

Objective To study the values of deceleration capacity of heart rate （DC）, heart rate deceleration runs （DRs）, acceleration capacity of heart rate （AC） and heart rate variability （HRV） in the evaluation of autonomic nervous function damage and the early warning of sudden cardiac death for DCM patients through analyzing the correlations among these four factors and left-ventricular ejection fraction （LVEF）.Methods The participants were selected from patients of our hospital from June 2012 to November 2016. Fifty-three patients with DCM, including 7 patients with slightly reduced LVEF, 12 patients with moderately reduced LVEF and 34 patients with severely reduced LVEF were allocated to the experimental group （DCM group）. Fifty- nine patients without organic heart disease were allocated to the control group. All patients received 24h electrocardiographic Holter examination. The data on DC, AC, DRs and all various parameters related to HRV, including SDNN, SDANN, rMSSD, pNN50,TP, vLF, LF, HF and LF/HF were automatically collected by computer, while the LVEF was measured by ultrasonic cardiography. The correlations among DC, AC, DRS as well as HRV and LVEF were analyzed statistically. Results The differences in DC, AC, DR1-DR10, SDNN, SDANN, rMSSD, pNN50, TP, vLF, LF and HF between DCM group and control group were statistically significant （P〈0.05）. The differences in DC, AC, DR1,DR3-DR10, SDNN, SDANN, TP, vLF, LF among patients with various LVEF were also statistically significant （P〈 0.05）.According to correlation analysis, DC, DRs（DR2,DR4,DR8）, SDNN, SDANN, TP, vLF and LF were positively correlated with LVEF, while AC is negatively correlated with LVEF, and the difference was statistically significant （P〈0.05）. Conclusion DC, DRs, AC and HRV can be used to evaluate autonomic nerve function damage in DCM patients and they are conducive to the early warning for sudden cardiac death.