心率变异性与扩张型心肌病患者预后的关系

Relationship of heart rate variability and prognosis of patients with dilated cardiomyopathy

目的探讨心率变异性(HRV)对扩张型心肌病(DCM)患者预后的影响。方法确诊为DCM的患者122例,根据窦性心搏R-R间期的标准差(SDNN)的最佳截断值64.5 ms,分为高HRV组(SDNN≥64.5 ms,79例)和低HRV组(SDNN<64.5 ms,43例)。比较两组基本临床资料。中位随访51个月,分析患者全因死亡的影响因素以及生存情况。结果高HRV组有非持续性或持续性室性心动过速、心肌肌钙蛋白T>14 ng/L患者比例少于低HRV组(P<0.05)。多因素Cox回归分析显示,SDNN<64.5 ms[HR=4.101,95%CI(1.238~13.585),P<0.05]、有病理性Q波[HR=4.565,95%CI(1.364~15.280),P<0.05]是DCM患者全因死亡的独立危险因素。Kaplan-Meier生存曲线分析显示,低HRV组DCM患者累计生存率低于高HRV组(P<0.05);在年龄<60岁和不同美国纽约心脏病学会心功能分级的DCM患者中,低HRV组累计生存率均低于高HRV组(P<0.05)。结论较低的HRV是DCM患者全因死亡的独立危险因素,与患者不良预后有关。

Objective To investigate the effect of heart rate variability(HRV)on the prognosis of the patients with dilated cardiomyopathy(DCM).Methods According to the cut-off value of SDNN 64.5 ms,122 patients diagnosed with DCM were divided into two groups of A(SDNN≥64.5 ms,79 cases)and B(SDNN<64.5 ms,43 cases).The baseline clinical characteristics of two groups were compared.The patients were followed up for a median time of 51 months,and the influencing factors for all-cause death and survival time were analyzed.Results The proportions of patients having nonsustained or sustained ventricular tachycardia and cardiac troponin T>14 ng/L in group A were less than those in group B(P<0.05).Multivariate Cox regression analysis showed that SDNN<64.5 ms[HR=4.101,95%CI(1.238-13.585),P<0.05]and having pathological Q wave[HR=4.565,95%CI(1.364-15.280),P<0.05J were the independent risk factors for all-cause death of DCM patients.Kaplan-Meier survival curve analysis showed that the cumulative survival rate of DCM patients in group B was lower than that in group A(P<0.05).So did the patients with age<60 years old or with different heart function classifications of NYHA(P<0.05).Conclusion Lower HRV is an independent risk factor for all-cause death and related with poor prognosis of DCM patients.