射血分数保留型心力衰竭患者心率变异性与左心室僵硬度的相关性

Correlation between heart rate variability and left ventricular stiffness in patients with heart failure with preserved ejection fraction

目的筛选反映射血分数保留型心力衰竭(heart failure with preserved ejection fraction,HFpEF)患者左心室僵硬度的敏感心率变异性(heart rate variability,HRV)指标,并评价其对HFpEF患者的预后评估价值。方法选取150例左心室射血分数(LVEF)正常的患者,行24 h动态心电图及常规超声心动图检查。将入选患者分成正常对照组(68例)和HFpEF组(82例)。采用受试者工作特征曲线分析,筛选HRV指标中能反映HFpEF患者左心室僵硬度的敏感指标,并对主要终点事件进行随访。结果在HRV指标中,SDANN预测HFpEF的曲线下面积最大,达0.68(P<0.01),cut-off值90 ms。SDANN与左心室舒张期室壁应变呈负相关;SDANN越高,左心室僵硬度就越高。根据SDANN的cut-off值,HFpEF患者被分为高SDANN组(cut-off值≥90 ms,44例)和低SDANN组(cut-off值<90 ms,38例)。低SDANN组左心室僵硬度较低。生存曲线分析显示,高SDANN组的主要不良心脏事件发生率和全因死亡率较低SDANN组显著升高(P<0.05)。结论SDANN可作为HFpEF患者临床诊断及预后评估的敏感指标。

Objective To screen out sensitive heart rate variability(HRV)index reflecting left ventricular(LV)stiffness in patients with heart failure with preserved ejection fraction(HFpEF),and to assess its prognostic evaluation value for HFpEF patients.Methods We selected 150 patients with normal LVEF who had undergone 24-hour ambulatory electrocardiography and routine echocardiography examinations.The enrolled patients were divided into normal control group(68 cases)and HFpEF group(82 cases).The receiver operating characteristic curve analysis was used to screen out the sensitive HRV index associated with LV stiffness in HFpEF patients.The primary endpoint events were followed up.Results Among HRV indexes,the area under curve(AUC)of SDANN was the largest in the prediction of HFpEF(AUC=0.68,P<0.01);the cut-off value was 90 ms.SDANN was negatively associated with LV diastolic wall strain.The higher the SDANN was,the higher the LV stiffness was.According to the cut-off value of SDANN,the patients with HFpEF were divided into high-SDANN group(cut-off value≥90 ms,44 cases)and low-SDANN group(cut-off value<90 ms,38 cases).In the low-SDANN group,the LV stiffness was lower.The survival curve analysis revealed that in the high-SDANN group the incidence of major adverse cardiac events and total mortality were significantly higher than those in the low-SDANN group(P<0.05).Conclusion SDANN could be served as a sensitive indicator for making clinical diagnosis and prognostic evaluation among patients with HFpEF.