高龄射血分数保留心力衰竭患者心率变异性及与心功能的关系

Heart Rate Variability in Elderly Patients with Heart Failure with Preserved Ejection Fraction and its Relationship with Cardiac Function

目的探讨高龄(年龄≥80岁)射血分数保留心力衰竭(HFpEF)患者的心率变异性(HRV)与心功能分级的相关性。方法收集2005年10月-2019年12月于北京市第二医院住院的高龄HFpEF患者60例为观察组,另选同期门诊就诊的无心力衰竭的高龄患者50例为对照组。比较两组患者HRV时域指标SDNN、SDNN指数、SDANN、r MSSD、三角指数、pNN50及频域指标HF、LF、LF/HF的变化,分析不同心功能分级时HRV时域指标的变化及HRV时域指标与心功能分级的相关性。结果观察组SDNN、SDNN指数、SDANN、rMSSD、三角指数、pNN50指标低于对照组,差异有统计学意义(P<0.05);NYHAⅢ级患者SDNN、SDNN指数、SDANN、rMSSD、三角指数、pNN50均低于NYHAⅡ级患者,NYHAⅣ级患者低于NYHAⅢ级患者,差异有统计学意义(P<0.05);观察组HRV频域指标HF、LF、LF/HF均低于对照组,差异有统计学意义(P<0.05);HRV时域指标与心功能分级呈负相关(P<0.05)。结论高龄HFpEF患者的HRV降低,自主神经功能受损。随着心功能不全加重,HRV时域指标进一步下降。HRV时域指标越低,代表心功能越差。

Objective To investigate the correlation between heart rate variability(HRV)and cardiac function classification in elderly patients(age≥80 years old)with heart failure with preserved ejection fraction(HFpEF).Methods 60 elderly patients with HFpEF hospitalized in Beijing Second Hospital from October 2005 to December 2019 were selected as observation group,and 50 elderly patients without heart failure were selected as control group.The changes of SDNN,SDNN index,SDANN,r MSSD,trigonometric index,pNN50 and frequency domain indexes HF,LF,LF/HF of HRV time domain indexes were compared between the two groups.The changes of HRV time domain indexes and the correlation between HRV time domain indexes and cardiac function classification were analyzed.Results The indexes of SDNN,SDNN index,SDANN,rMSSD,trigonometric index and pNN50 in the observation group were lower than those in the control group,the difference was statistically significant(P<0.05).The indexes of SDNN,SDNN index,SDANN,rMSSD,trigonometric index and p NN50 in NYHA grade Ⅲ patients were lower than those in NYHA grade Ⅱ patients,and those in the NYHA grade Ⅳ patients were lower than those in NYHA grade Ⅲ patients,the difference was statistically significant(P<0.05).The frequency domain indexes HF,LF and LF/HF of heart rate variability in the observation group were lower than those in the control group,and the difference was statistically significant(P<0.05).HRV time domain indexes were negatively correlated with cardiac function classification(P<0.05).Conclusion The HRV of elderly HFpEF patients is reduced,and the autonomic nerve function is impaired.With the aggravation of cardiac insufficiency,HRV time domain index decreased further.The lower the HRV time domain index,the worse the cardiac function.