合并室性心律失常的心衰患者病情严重程度与心率变异变化的相关性分析

An of the correlation between severity of heart failure and heart rate variability in patients with ventricular arrhythmia

目的:分析合并室性心律失常的心力衰竭(下称心衰)患者病情严重程度与心率变异变化的相关性。方法:前瞻性选取我院连续收治的123例心衰合并室性心律失常患者设为观察组,同期连续收治的30例无室性心律失常的心衰患者,设为对照组。比较两组基础疾病、NYHA心功能分级、左心室射血分数(LVEF),基于心功能分级分析患者病情严重程度与心率变异性(HRV)的关系。根据随访结果分析出院患者发生心血管复合终点事件的危险因素。结果:就HRV参数时域指标(SDANN、SDNN Index、SDANN Index、RMSSD、PNN50)、频域指标(HF、LF、VLF)而言,观察组各指标均明显低于对照组(P<0.05)。观察组不同心功能分级患者各指标比较均存在显著差异(P<0.05),其中,Ⅳ级患者HRV参数各指标均明显低于Ⅱ级、Ⅲ级患者(P<0.05);各指标与心功能分级呈显著负相关(P<0.05)。就心血管复合终点事件而言,发生68例(44.4%),发生组合并室性心律失常明显多于、各HRV参数指标均明显低于未发生组(P<0.05);COX分析结果显示,SDANN Index、LF、及合并室性心律失常为其危险因素(P<0.05)。结论:合并室性心律失常的心衰患者病情严重程度与心率变异变化呈显著负相关;SDANN Index、LF、及合并室性心律失常为心血管复合终点事件发生的危险因素,HRV参数检测可有助于病情评估、预后预测,需重点关注时间段为首次入院第一次行12导联动态心电图后的2~4个月。

Objective:To analyze the correlation between the severity of heart failure and heart rate variability in patients with heart failure(hereinafter referred to as heart failure)with ventricular arrhythmia.Methods:123 patients with heart failure and ventricular arrhythmia were selected prospectively as observation group,30 patients without ventricular arrhythmia treated continuously in the same period were set as the control group.The basic diseases,NYHA cardiac function classification and left ventricular ejection fraction(LVEF)were compared between the two groups.The relationship between the severity of disease and heart rate variability(HRV)was analyzed based on the cardiac function classification.According to the follow-up results,the risk factors of cardiovascular composite endpoint events were analyzed.Results:In terms of HRV parameter time domain indexes(SDANN,SDNN Index,SDANN Index,RMSSD,PNN50)and frequency domain indexes(HF,LF,VLF),the indexes of the observation group were significantly lower than those of the control group(P<0.05).There were significant differences in the indicators of patients with different cardiac function classifications in the observation group(P<0.05).Among them,the HRV parameters of patients in gradeⅣwere significantly lower than those in gradesⅡandⅢ(P<0.05).The classification showed a significant negative correlation(P<0.05).In terms of cardiovascular composite endpoint events,68 cases(44.4%)occurred,combined ventricular arrhythmia occurred significantly more,and each HRV parameter index was significantly lower than the non-occurring group(P<0.05);COX analysis results showed that,SDANN Index,LF,and combined ventricular arrhythmia are risk factors(P<0.05).Conclusion:The severity of heart failure patients with ventricular arrhythmia is significantly negatively correlated with heart rate variability;SDANN index,LF,and ventricular arrhythmia are risk factors of cardiovascular composite endpoint events,HRV parameter detection could help to assess the condition and predict the prognosis,and the time period needed to be focused is 2-4 months after the first 12 lead Holter.