心率减速力与连续心率减速力对扩张型心肌病患者预后的预测价值

Predictive value of decelerration capacity of rate and heart rate deceleratian runs on prognosis of patients with dilated cardiomyopathy

目的探讨心率减速力(decelerration capacity of rate,DC)与连续心率减速力(heart rate deceleration runs,DRs)对扩张型心肌病(dilated cardiomyopathy,DCM)患者预后的预测价值。方法选择2017年1月至2019年12月在佛山市第一人民医院心内科住院的DCM患者96例(DCM组)和非器质性心脏病患者100例(对照组)进行24 h动态心电图检测和心脏超声检查。在DCM患者中,根据有无发生心源性猝死将患者分为高危组21例和低危组75例。按纽约心脏协会(New York Heart Association,NYHA)心功能分级分为Ⅱ级组21例,Ⅲ~IV级组75例。根据心律失常发生情况分为室性心动过速(室速)组(阵发性室速或短阵室速)26例,室性期前收缩(室早)组(频发室早>100次/24 h)50例和无室性心律失常组20例。应用动态心电图分析软件记录DC值和DRs值,比较各组DC、DRs及DC、DRs与心源性死亡的相关性。采用多因素COX回归分析对DCM患者心源性死亡的发生因素进行分析。结果高危组患者DC、DRs、左心室射血分数(left ventricular ejection fraction,LVEF)显著低于低危组,差异有统计学意义(P<0.01)。室速组患者DC、DRs显著低于室早组和无室性心律失常组,差异有统计学意义(P<0.01);室早组患者DC、DRs显著低于无室性心律失常组,差异有统计学意义(P<0.01)。NYHA心功能Ⅲ~Ⅳ级组患者DC、DRs显著低于NYHAⅡ级组,差异有统计学意义(P<0.05)。多重线性回归分析显示DC、DRs与心源性猝死、室性心律失常、NYHA分级、LVEF相关(P<0.05)。多因素COX回归分析显示DC、DRs降低是心源性死亡的危险因素。结论 DC、DRs有望成为预测DCM患者预后的重要指标,是DCM患者心源性死亡的危险因素。DC、DRs检测可稳定评估DCM患者迷走神经功能,值得在临床应用推广。

Objectives To investigate the predictive value of decelerration capacity of rate(DC)and heart rate decel⁃eratian runs(DRs)on prognosis of patients with dilated cardiomyopathy(DCM).Methods From January 2017 to December 2019 in the Department of Cardiology of The First People′s Hospital of Foshan,DC and DRs value were detected in 96 patients with DCM(DCM group)and 100 patients with non-organic heart disease(control group)by using 24 h dynamic electrocardiogram,and the cardiac struture and function were detected by echocardiography.In DCM group,patients were classified into high-risk group(n=21)and low-risk group(n=75)according to whether they suffered sudden cardiac death or not;patients were grouped in to ventricular tachycardia(VT)group(paroxysmal VT or burst VT,n=26),premature ventricualr contraction(PVC)group(PVC>100 times/24 h,n=50)and non-ven⁃tricular arrhythmia(VA)group(n=20)according to whether they suffered VA or not;patients were classified into New York Heart Association(NYHA)heart function gradeⅡgroup(n=21)andⅢ-IV group(n=75).DC and DRs among the groups were compared.Correlations between DC,DRs and cardiac death were analyzed.Risk factors of cardiac death in patiens with DCM were analyzed by multivariate COX regression.Results DC,DRs and left ventricular ejection fraction(LVEF)in high-risk group were significantly lower than that of low-risk group(P<0.01).DC,DRs in VT group were significanty lower than those of PVC group and non-VA group(P<0.01).DC,DRs in NYHA heart function gradeⅡgroup were significantly lower than those of NYHA heart function gradeⅢ-IV group(P<0.05).Mul⁃tiple liner regression analysis showed that DC and DRs associated with sudden cardiac death,VA,NYHA heart func⁃tion grade,LVEF(P<0.05).Multivariate COX regression analysis showed that the reduction of DC and DRs were risk factors for cardiac death.Conclusions DC and DRs could predict the prognosis of patients with DCM and they are the risk factors of patients with DCM suffered from cardiac death.Detection of DC and DRs can stably evaluate the function of pneumogastric nerve and it is worth to applying in clinical.