慢性心力衰竭患者的长程心电图大数据散点图特征观察及分析

Observation and analysis of 24 hours electrocardiogram using scattergram data in patients with chronic heart failure

目的利用单导长程心电图大数据散点图观察并分析慢性心力衰竭(简称心衰)患者的心脏节律特点。方法因慢性心衰急性发作入院的患者,经治疗症状稳定,且口服药物能控制症状后,采用单导心电记录仪(电极贴片纵向粘贴于胸骨柄处,电极间距10.8cm)记录患者的24h长程心电图。用相应的配套软件导入心电数据,利用散点图分析界面及逆向心电图技术,结合直方图逆向技术,逐波分析心电波形,精确诊断每一心搏。根据患者心律失常发生个数占总心搏个数的百分比<0.1%、0.1%~1%、>1%将患者分为罕发组、偶发组和频发组。观察各组患者散点图的形态及分布特征,并比较3组性别、年龄、心率和心脏超声指标;比较病因及血浆脑钠肽(BNP)含量。再将患者按平均心率<60次/分、60~79次/分、≥80次/分分为心率缓慢组、正常组和增快组,比较相应指标。结果总体60例心衰患者,排除非窦性心律及其他病例后,41例窦性心律患者最终入选,所有病例均表现出自身心电散点特点。罕发组、偶发组和频发组分别有13例、17例和11例患者。罕发组Lorenz-RR散点图整体表现为主导节律周围很稀疏的散点分布;24h房性早搏(简称房早)和室性早搏(简称室早)发生个数的中位数分别为69次和3次,窦房阻滞发生1例。偶发组Lorenz-RR散点图整体表现为主导节律外散点较多分布,分布面积较大者较稀疏,分布面积较小者较密集,呈单分布或多分布;24h房早和室早数的中位数分别为160次和26次,短阵室性心动过速(简称室速)4例,窦房结功能分离3例,各类传导阻滞4例。频发组Lorenz-RR散点图整体表现为散点分布密集型,呈多分布或团块状分布;24h房早和室早数的中位数分别为2 256次和415次,室速2例,窦房传导阻滞1例。3组间年龄、性别、心脏超声指标、病因和BNP等比较,无显著差异(P均>0.05)。按心率分组中,与正常组比较,心率增快组最快心率和最慢心率均明显变快[(122±16)次/分vs(109±18)次/分和(63±8)次/分vs(52±8)次/分,P均<0.05];而增快组年龄相对较小,但无显著差异[(62±6)岁vs(68±9)岁,P=0.068];病因分布的差异不明显(P=0.078)。结论慢性心衰患者的单导长程心电散点图形态特点可直观反映其心脏节律性质,有助于指导心衰患者的节律控制治疗。

Objective Observe and analyze the cardiac rhythm characteristics of patients with chronic heart failure （HF） by using seattergram data of mono-lead 24 hours electrocardiogram （ECG）. Methods In patients hospitalized for acute onset of heart failure and stable （oral medication was ableto control the symptoms） after treatment,a mono-lead ECG instrument （ECG electrodes of patch type, longitudinally pasted on the manubrium sterni, with a distance of 10.8 cm） was used to record the patient＇s 24 hour long-term ECG. Utilizing analyze interface of scattergram, combined with reverse techniques of ECG and histogram, the ECG data were input into the computer with supporting software, analyzed ECG waveform one by one, and then diagnosed every heart beat accurately. According to the percentage of cardiac arrhythmia in total heart beat, the patients were divided into the rare group, the sporadic group and the frequent group by 〈 0.1%, 0.1%-1%, and 〉1%. The morphological and distribution characteristics of scattergram in each group were observed, and gender, age, heart rate, cardiac ultra sound parameters, causes, and plasma brain natriuretic peptide （BNP） concentration of these groups were compared. According to the average heart rate of 〈 60 bpm , 60-79 bpm, and ≥80 bpm, the patients were divided into the slow group, the normal group and the fast group, and compared the relevant index. Results Total of 60 cases of HF patients, after the exclusion of non sinus rhythm and other cases, 41 patients with sinus rhythm was cho sen, all cases manifested the scatter characteristics themselves. There were respectively 13, 17 and 11 cases in the rare group, the sporadic group and the frequent group; Lorenz-RR scattergram of the rare group showed a sparse distribution of scattered points around the dominant rhythm. The median of 24-hour premature atrial contraction （PAC） and premature ventricular contraction （PVC） were 69 and 3 separately, and 1 case of sinoatrial block was observed; The overall performance of Lorenz RR scattergram in the sporadic group was that more scattered points distributed beyond the dominant rhythm- the larger the area, the sparser the distribution; and the smaller, the denser, showing a single or multiple distribution. The median of 24-hour PAC and PVC were 160 and 26 respectively, and 4 cases were nonsustained ventricular tachycardia （VT）, 3 cases were separated sinus node function, and 4 cases of conduction block. The scattered points of Lorenz-RR diagram in the frequent group were concentrated in a multiple or agglomerate distribution. The median of 24-hour PAC and PVC were 2256 and 415 separately. Two cases of VT and 1 case of sinoatrial conduction block. There was no statistic significance in age, gender, cardiac ultra- sound parameters, etiology and BNP in 3 groups （all P〉0.05）. According to heart rate grouping, the maximum and minimum heart rate in the fast group were both significantly faster than these in the normal group [ （122±16） bpm vs （109±18） bpm and （63±8） bpm vs （52±8） bpm, all P〈0.05]; and the age was relatively younger, but there was no significant difference [（62±6） years vs （68±9） years, P=0.068]; The difference of etiology was not obvious （P=0.078）. Conclusions The morphological characteristics of mono-lead 24 h dynamic ECG scattergram in patients with HF can directly reflect the nature of cardiac rhythm and can help guide the rhythm control treatment of patients with HF.