动态心电图心率变异性与冠心病PCI术后预后的相关性

Correlation between abnormal changes of dynamic electrocardiogram and prognosis of coronary heart disease and heart failure after PCI

目的 探讨动态心电图心率变异性与冠状动脉粥样硬化性心脏病(简称冠心病)心力衰竭患者经皮冠状动脉介入(PCI)术后预后的相关性。方法 选取2020年1月—2021年1月本院因冠心病心力衰竭行PCI术的患者176例,根据随访期间不良心血管事件发生情况分为预后良好组(n=148)与预后不良组(n=28)。比较两组患者一般资料及PCI术前、术后动态心电图指标变化(心率、心搏数、最长R-R间期及心率变异性参数24 h内全部正常的窦性R-R间期的标准差(SDNN)、连续24 h的5 min正常R-R间期标准的均值(SDNN Index)、5 min窦性R-R间期平均值的标准差(SDANN)、正常的相邻心动周期间差值的均方根(r-MSSD)及三角指数;采用多因素Logistic回归法分析影响冠心病心力衰竭PCI术后预后的相关因素;创建受试者工作特征曲线(ROC),分析术前动态心电图对冠心病心力衰竭PCI术后预后的预测价值。结果 与预后良好组术前比较,预后不良组术前心率、心搏数升高,最长R-R间期、SDNN、SDANN、SDNN Index、r-MSSD及三角指数降低(P<0.05);与术前相比,预后良好组、预后不良组术后心率、心搏数降低,最长R-R间期、SDNN、SDANN、SDNN Index、r-MSSD及三角指数升高(P<0.05);与预后良好组单支、多支病变相比,预后不良组单支、多支病变患者术前心率、心搏数升高,最长R-R间期、SDNN、SDANN、SDNN Index、r-MSSD及三角指数降低(P<0.05);两组单支、多支病变患者之间术前心率、心搏数、最长R-R间期、SDNN、SDANN、SDNN Index、r-MSSD及三角指数比较,差异均无统计学意义(P>0.05);多因素Logistic回归分析显示,术前SDNN、SDANN、SDNN Index、r-MSSD及三角指数为冠心病心力衰竭PCI术后预后不良的影响因素(P<0.05);ROC曲线显示,术前SDNN、SDANN、SDNN Index、r-MSSD、三角指数对冠心病心力衰竭PCI术后不良预后的预测价值较高,联合检测时敏感度、特异度及ROC曲线下面积更高。结论 术前动态心电图异常改变对冠心病心力衰竭PCI术后预后的预测价值较高。

Objective To investigate the correlation between abnormal changes of dynamic electrocardiogram and the prognosis of patients with coronary atherosclerotic heart disease after percutaneous coronary intervention(PCI).Methods A total of 176 patients undergoing PCI due to CHD and heart failure in our hospital from January 2020 to January 2021 were selected,and were divided into good prognosis group(n=148)and poor prognosis group(n=28)according to the incidence of adverse cardiovascular events during follow-up.The general data and changes of holter ECG indexes before and after PCI were compared between the two groups,including the standard deviation(SDNN)of all normal sinus R-interval within 24 h,heart rate,stroke number,longest R-interval and heart rate variability parameters,the standard mean(SDNN Index)of normal R-interval for 5 consecutive hours,5 The standard deviation of the mean value of the min sinus R-R interval(SDANN),the root mean square of the difference between normal adjacent pericardial periods(r-MSSD),and the trigonal index were measured.Multifactor Logistic regression method was used to analyze the related factors affecting the prognosis of coronary heart failure after PCI.Receiver operating characteristic curve(ROC)was established to analyze the prognostic value of preoperative holter electrocardiogram in patients with coronary heart failure after PCI.Results Compared with the group with good prognosis before operation,in the poor prognosis group,the heart rate and the number of heart beats increased,and the longest R-R interval,SDNN,SDANN,SDNN Index,r-MSSD and trigonometric index decreased(P<0.05).Compared with that before operation,the heart rate and heart beat number of patients with good prognosis and patients with poor prognosis decreased,and the longest R-R interval,SDNN,SDANN,SDNN Index,r-MSSD and trigonometric index increased(P<0.05).Compared with single vessel and multi vessel lesions in the group with good prognosis,the patients with single vessel and multi vessel lesions in the group with poor prognosis had higher heart rate and number of heart beats before operation,and the longest R-R interval,SDNN,SDANN,SDNN Index,r-MSSD and trigonometric index decreased(P<0.05).There was no significant difference in preoperative heart rate,number of beats,longest R-R interval,SDNN,SDANN,SDNN Index,r-MSSD and trigonometric Index between the two groups with single vessel and multi vessel lesions(P>0.05).Multivariate Logistic regression analysis showed that SDNN,SDANN,SDNN Index,r-MSSD and triangle Index before operation were the influencing factors of poor prognosis after PCI for coronary heart disease and heart failure(P<0.05).The ROC curve showed that SDNN,SDANN,SDNN Index,r-MSSD and triangle Index before operation had high predictive value for poor prognosis of coronary heart failure after PCI,and the diagnostic sensitivity,specificity and area under the ROC curve were higher when combined detection was performed.Conclusion The abnormal changes of dynamic electrocardiogram before operation have a high predictive value for the prognosis of coronary heart disease and heart failure after PCI.