老年射血分数保留的心力衰竭患者心率变时功能研究及相关因素分析

Study of chronotropic function and its influence factors in elderly patients with heart failure with preserved ejection fraction

目的探讨射血分数保留心力衰竭(HFpEF)患者心率变时功能及相关因素。方法选取住院治疗的老年HFpEF患者36例作为HFpEF组,另选32例性别、年龄匹配的无心力衰竭症状的体检者为对照组,两组分别进行运动负荷试验、心脏彩超检查,对比两组临床特征、生化指标、心脏彩超、运动负荷试验心率结果,分析心率变时功能指标心率储备分数的影响因素。结果HFpEF组患者体重指数明显高于对照组,更多合并有高血压病、糖尿病、心房颤动,脑钠肽显著高于对照组(P均<0.05);HFpEF组左室重量指数,左房内径,舒张功能指标E/e′显著增高(P均<0.05);HFpEF组峰值心率[(127±15)次/分vs(145±11)次/分],心率储备[(42±9)次/分vs(59±11)次/分],及心率储备分数[(0.57±0.11)vs(0.75±0.24)]均显著低于对照组(P<0.05),运动后1、2、3 min心率恢复值也显著低于对照组(P<0.05)。老年HFpEF患者心率储备分数与E/e′间呈负相关(R=-0.617,P<0.05)。结论老年HFpEF患者存在心率变时功能不良,与左室舒张功能不全相关。

Objective To investigate chronotropic function and its influence factors in elderly patients with heart failure with preserved ejection fraction(HFpEF).Methods Thirty-six elderly HFpEF inpatients were enrolled as the HFpEF group and 32 healthy individuals with similar age and gender distribution were enrolled as the control group.All participants underwent exercise test and echocardiogram.Clinical characteristics,laboratory examinations,echocardiographic parameters and heart rate in exercise test was compared between groups to investigate the influence factor of chronotropic function,indicated as heart rate reserve ratio(HRRR).Results Mean body mass index of HFpEF patients was higher than healthy controls,and the comorbidities,such as hypertension,diabetes mellitus and atrial fibrillation were more frequent in HFpEF group,the value of BNP was higher in HFpEF.Left ventricular mass index,left atrial diameter,E/e′in echocardiographic examination was higher in HFpEF.In exercise test,peak heart rate[(127±15)bpm vs(145±11)bpm],heart rate reserve[(42±9)bpm vs(59±11)bpm]and HRRR[(0.54±0.11)bpm vs(0.75±0.24)bpm]was lower in HFpEF group,heart rate recovery 1,2,3 minutes after peak heart rate was reduced compared to the controls.In correlation analysis,HRRR was negative correlated to index of diastolic function E/e′(R=-0.617,P<0.05).Conclusion Elderly HFpEF patients have impaired chronotropic incompetence during maximal exercise,which is inversely correlated with left ventricle diastolic function.