心率减速力评估慢性心衰患者的预后

目的探讨心率减速力对老年慢性心功能不全（CHF）患者预后的预测价值。方法入选安徽省立医院2008年10月至2011年10月住院的老年CHF患者124例,同期选择82例健康患者为对照组,记录其相关临床资料,并进行超声心动图、动态心电图检查。应用相应的分析软件对动态心电图检查结果进行分析,比较不同心功能分级患者DC指标变化的差异;随访12~24个月,终点事件为患者心源性死亡,采用Logisitc回归法分析DC、年龄、高血压、糖尿病、心肌梗死、左室射血分数（LVEF）、血管紧张素转换酶抑制剂（ACEI）对CHF患者死亡的预测能力。结果对照组与心功能不全组比较,DC差别显著,同时DC在心功能Ⅱ级组和Ⅲ级组有明显差异,但在心功能Ⅲ级与心功能Ⅳ级组无差别（p〉0.05）。平均随访（15士8.5）个月,124例患者中,心源性死亡24例,分析显示CHF患者死亡与DC、低LVEF（≤45%）、年龄（≥65岁）、糖尿病、心肌梗死及心功能分级相关。结论DC指标对老年人CHF预后有良好的预测能力。

Prognostic value of deceleration capacity of heart rate in patients with chronic heart failure

Objective To investigate the prognostic value of deceleration capacity （DC） in patients with chronic heart failure（CHF）.Methods From 0ctober 2008 to 0ctober 2011,a total of 124 elderly CHF inpatients were selected,and the clinic data were recorded.Based on the echocardiogram and dynamic electrocardiogram,the differences of sinus DC index of patients with different cardiac function classification were analyzed.During 12～24 months medical follow-up,the treatment endpoint was death from heart disease.Based on Logisitc regression,the prognostic values of DC,age,hypertension,diabetes,myocardialinfarction （MI）,left ventricular ejection fraction and ACEI for death of CHF patients were analyzed.Results There was significant difference in DC between the patients with chronic heart failure and normal group （p〈0.05）.No significant differences were found in between grade Ⅲ and grade Ⅳ cardiac function （p〉0.05）.But there was significant difference in DC between grade Ⅱ and grade Ⅲ cardiac function patients （p〈0.05）.The average follow-up time was （15 ± 8.5）months.Of all 124 patients,there were 24 dead of heart disease.There were correlations of death of CHF with DC,low LVEF（≤45%）,age（≥65 years）,diabetes,MI and classification of heart function.Conclusions The sinus DC in CHF patients has a favorable prognostic value.