慢性心力衰竭患者的动态心电图Lorenz散点图特点及与预后的关系探讨

Characteristics of Lorenz scatter plot of ambulatory Holter electrocardiogram in patients with chronic heart failure and its correlation with prognosis

目的对比慢性心力衰竭预后良与预后不良患者的动态心电图Lorenz散点图的特点,分析动态心电图Lorenz散点图与慢性心力衰竭患者预后的关系。方法 130例慢性心力衰竭患者作为研究对象,对所有患者进行动态心电图检查,常规治疗后随访,根据患者的预后效果分为预后良好组(75例)和预后不良组(55例)。比较两组患者心电图异常情况[频发房性早搏、频发室性早搏、ST-T改变、传导阻滞以及心房颤动(房颤)]及Lorenz散点图分布特点(绕坐标45°线的棒球拍形和彗星状,扇形、四分布形以及格子状形,不规则型和复杂型)。结果预后良好组患者频发房性早搏、频发室性早搏、ST-T改变、传导阻滞以及房颤的发生率分别为13.3%、12.0%、6.7%、8.0%、4.0%,均低于预后不良组的32.7%、29.1%、18.2%、20.0%、16.4%,差异均具有统计学意义(P<0.05)。预后良好组患者绕坐标45°线的棒球拍形和彗星状发生率为69.3%,高于预后不良组的23.6%,差异具有统计学意义(P<0.05);预后良好组扇形、四分布形以及格子状形发生率为13.3%,不规则型和复杂型发生率为17.3%,均低于预后不良组的36.4%、40.0%,差异均具有统计学意义(P<0.05)。结论动态心电图Lorenz散点图的分布特点与慢性心力衰竭的预后有关,可作为慢性心力衰竭诊疗的评估手段。

Objective To compare the characteristics of Lorenz scatter plot of ambulatory Holter electrocardiogram in patients with chronic heart failure and analyze the correlation between Lorenz scatter plot of ambulatory Holter electrocardiogram and prognosis of patients with chronic heart failure. Methods A total of 130 patients with chronic heart failure as study subjects, and all patients were examined by ambulatory Holter electrocardiogram and were followed up after routine treatment. They were divided into good-prognosis group(75 cases) and bad-prognosis group(55 cases) according to their prognosis. The occurrence of abnormal electrocardiogram(frequent atrial premature beats, frequent ventricular premature beats, ST-T changes, conduction block and atrial fibrillation) and characteristics of Lorenz scatter plot(baseball racket and cometshaped around the 45° line, fan shape, four distribution shape and lattice shape, irregular type and complex type) were compared between the two groups. Results The incidence of frequent atrial premature beats, frequent ventricular premature beats, ST-T changes, conduction block and atrial fibrillation of good-prognosis group were 13.3%, 12.0%, 6.7%, 8.0% and 4.0%, which were lower than those of poor-prognosis group 32.7%, 29.1%, 18.2%, 20.0% and 16.4%, and the difference was statistically significant(P<0.05). The incidence of baseball racket and comet-shaped around the 45° line of good-prognosis group was 69.3%, which was higher than that of poor-prognosis group, and the difference was statistically significant(P<0.05). The incidence of fan shape, four distribution shape and lattice shape of good-prognosis group was 13.3%, and incidence of irregular type and complex type was 17.3%, which were lower than those of poor-prognosis 36.4% and 40.0%, and the difference was statistically significant(P<0.05). Conclusion The distribution of Lorenz scatter plot is correlated with the prognosis of chronic heart failure, and it can be used as an evaluation method for diagnosis and treatment of chronic heart failure.