心率及心率变异性对慢性心衰的评估价值研究

Evaluation of heart rate and heart rate variability in patients with chronic heart failure

目的分析左心室射血分数(LVEF)与心率、心率变异性之间的相关性,探讨心率、心率变异性对慢性充血性心力衰竭的评估价值。方法将137例慢性充血性心力衰竭患者作为研究对象,要求入选的研究对象心功能Ⅲ~Ⅳ级且LVEF≤40%,分为A组(30%<LVEF≤40%)、B组(LVEF≤30%),进行24h动态心电图检查,获得患者心率及心率变异性各项时域和频域指标,进行统计分析。结果B组的平均心率、最慢心率较A组增加,差异具有统计学意义(P<0.05),而总心搏数、最快心率差异无统计学意义。心率变异性的时域指标分析发现,B组的SDNN、SDANN、三角指数均较A组的降低,两组患者差异具有统计学意义(P<0.05),而SDNNindex、r-MSSD、PNN50差异无统计学意义。频域指标分析发现,B组的HF、LF/HF较A组均降低,但差异无统计学意义。而B组的LF较A组明显降低,差异具有统计学意义(P=0.008<0.05)。结论慢性心力衰竭患者中平均心率、最慢心率随着LVEF下降而增加,SDNN、SDANN、三角指数随着LVEF的下降而降低,LF随着LVEF的恶化下降得更明显。

Objective To explore the change of heart rate and heart rate variability (HRV) in patients with chronic congestive heart failure (CHF), and find their evaluation value of left ventricular ejection fraction (LVEF). Methods A total of 137 patients with CHF were enrolled. The cardiac function (NYHA) of all the parameters were between grade Ⅲ~Ⅳ, and LVEF≤40%. The parameters were divided into group A(30%<LVEF≤ 40%)and group B(LVEF≤30%), 24 h ambulatory electrocardiograph were performed to obtain the heart rate and HRV indicators for statistical analysis. Results Compared with group A, the average and the slowest heart rate increased in group B, and the difference was statistically significant (P< 0.05). However, no statistically significant difference was found in the total and the fastest heart rate. The time-domain index of HRV such as SDNN, SDANN and triangular index were lower in group B, and the difference between the two groups was statistically significant (P<0.05), while SDNN index, r-MSSD and PNN50 were not found to be statistically significant. The frequency domain index analysis found that the HF and LF/HF of group B were lower than that of group A, but there was no statistical difference. LF in group B was significantly lower than that in group A (P=0.008< 0.05). Conclusion In patients with CHF, the average and slowest heart rate increased with the decrease of LVEF, SDNN, SDANN and triangular index decreased with the decrease of LVEF, and LF decreased more significantly with the deterioration of LVEF.