心率减速力对慢性心力衰竭患者心源性死亡的预测价值

Prognostic Value of Deceleration Capacity for the Patients with Chronic Heart Failure

目的:探讨心率减速力(DC)对慢性心力衰竭患者心源性死亡的预测价值。方法:选择208例慢性心力衰竭(CHF)患者和80例正常对照者为研究对象,检测和比较两组DC、心率变异性(HRV)、左心室射血分数(LVEF)、左室舒张末内径(LVEDD)、C反应蛋白(CRP)和平均心率(mH R)等指标,随访6～18个月,终点事件是心源性死亡。结果:心衰患者DC较健康对照组明显下降(4.39±1.05 ms vs. 6.36±0.32 ms, P<0.001),慢性心衰患者发生心源性性死亡较存活着DC明显减低(3.52±1.83 ms vs. 4.53±0.85 ms,P=0.002),单变量分析年龄≥65岁、LVEF≤30%、CRP≥11.8 mg/L、SDNN≤70 ms和平均心率(mH R)≥75次/min和DC<4.5 ms等6个变量对终点事件有预测价值;多变量分析结果显示仅年龄≥65岁、LVEF≤30%、SDNN≤70 ms和DC<4.5 ms对心源性死亡有预测价值(P<0.05),DC相对危险度为3.14。结论:心力衰竭患者DC减低,DC是心功能慢性心力衰竭患者心源性死亡的独立危险因子。

Objective： To evaluate the prognostic value of deceleration capacity（DC） for predicting cardiac death in CHF patients.Methods： 208 cases of chronic heart failure（CHF） patients and 80 normal controls were enrolled, the DC, HRV, left ventricular ejection fraction（LVEF）, left ventricular end diastolic diameter（LVEDD）, C-reactive protein（CRP） and mean heart rate（m HR） were recorded,then the patients were followed up for 6-18 months, the end point were cardiac death. Results： DC were significantly lower in the CHF group than that of the healthy group（4.39±1.05 ms vs 6.36±0.32 ms, P〈0.001）, DC was significantly lower in the cardiac deaths group than that of the survival group（3.52±1.83 ms vs 4.53±0.85 ms, P=0.001）. Univariate analysis showed that DC4.5 ms, age≥65 years,LVEF≤30%, SDNN≤70 ms, CRP≥11.8 mg/L and RHR≥75 bpm could predict the end point. Multivariate analysis showed that only LVEF≤30%, SDNN≤70 ms and DC4.5 ms had predictive values. The relative risk of DC was 3.14. Conclusion： DC was decreased in the patient with CHF and was an independent risk factor for the cardiac death in CHF patients.