窦性心率震荡现象对慢性心力衰竭患者预后评估的临床意义

目的:探讨窦性心率震荡(HRT)在心力衰竭患者中的变化,阐明其对于评估心力衰竭患者预后的临床意义。方法:选择50例慢性心力衰竭(CHF)患者及25名正常对照者。测定CHF患者入院后24 h内血清脑钠肽(BNP)水平;超声心动图测量所有研究对象左心室射血分数(LVEF)和左心室舒张末期内径(LVEDD),并行动态心电图检查,获取震荡初始(TO)值和震荡斜率(TS)值;比较心衰组、对照组研究对象的TO、TS、LVEF、LVEDD值、BNP水平和HRT分级,随访患者出院后主要心血管事件、死亡、因心衰加重入院等不良预后;采用Logisitic回归分析死亡与HRT分级的关系。结果:CHF组患者TO和LVEDD值高于对照组(P<0.01)、TS值和LVEF值低于对照组(P<0.01)。中、重度CHF组患者TO值、BNP水平和LVEOD值高于轻度CHF组(P<0.05或P<0.01),中、重度CHF组患者TS和LVEF值明显小于轻度CHF组(P<0.01)。预后良好的患者TS值明显高于预后不良者(P<0.05),TO值明显低于预后不良者。TO值与BNP水平和LVEDD值呈正相关关系(r=0.330,r=0.349,P<0.05),与LVEF值呈负相关关系(r=-0.44,P<0.05);TS值与BNP水平呈负相关关系(r=-0.403,P<0.05),与LVEF值呈正相关关系(r=0.326,P<0.05)。死亡患者的TO值和BNP水平明显高于生存的患者,TS值和LVEF值明显低于生存患者(P<0.05)。死亡与HRT分级呈正相关关系(r=0.153,P<0.05)。结论:CHF患者HRT明显减弱,其对CHF患者心源性猝死及预后有预测价值。

Clinical significance of heart rate turbulence in prognosis assessment of patients with chronic heart failure

Objective To investigate the changes of heart rate turbulence (HRT) in the patients with heart failure,and to clarify its clinical significance in the prognosis assessment of the patients with heart failure.Methods 50 patients with chronic heart failure(CHF) (CHF group) and 25 normal controls (control groups) were selected. The levels of serum brain natriuretic peptide (BNP) within 24 h after admission in CHF patients were detected,and the values of left ventricular ejection fraction(LVEF)and left ventricular end diastolic diameter (LVEDD) of all the 75 subjects were measured by echocardiography; the values of turbulence onset(TO) and turbulence slope (TS) were obtained by Holter analysis. The values of TO,TS,LVEF,LVEDD,levels of BNP,and HRT grading were compared between CHF group and control group.And the major cardiovascular events,mortality and repeated episodes of the hospitalization for the heart failure symptoms after discharge were recorded; Logisitic regression analysis was used to analyze the relationship between the death and HRT grading.Results The value of TO and value of LVEDD of the patients in CHF groups were significantly higher than those in control group(P<0.01),and the value of TS and value of LVEF were significantly lower than those in control group(P<0.01).The value of TO,level of BNP,and value of LVEDD of the patients in moderate and severe heart failure group were slightly higher than those in mild heart failure group(P<0.05,P<0.01),and the value of TS and value of LVEF were significantly lower than those in mild heart failure group(P<0.01).The value of TS of the patients with good prognosis was significantly higher than that of the patients with poor prognosis(P<0.05),and the value of TO was significantly lower(P<0.05). There were positive relationship between the value of TO and level of BNP and value of LVEDD(r=0.33,r=0.349,P<0.05) and negative relationship with value of LVEF(r=-0.440,P<0.05).There were positive relationship between the value of TS and value of LVEF(r=0.326,P<0.05)and negative relatiohship with level of BNP(r=-0.403,P<0.05). The value of TO and level of BNP of the patients in mortality group were significantly higher than those in survival group(P<0.05),and the values of TS and LVEF were significantly lower than those in control group(P<0.05).Conclusion HRT significantly is reduced in the CHF patients,and the decreasing of HRT has the prognostic significance in the CHF patients.