目的 探讨缺血性心肌病(ischemic cardiomyopathy, ICM)患者窦性心律震荡(heart rate turbulence, HRT)程度与心功能分级的关系。方法 选取动态心电图显示室性期前收缩的ICM患者96 例(ICM组)及无心力衰竭的冠心病患者(对照组)75例进行研究。对所有入选患者进行纽约心脏病协会(NYHA)心功能分级, 分别测量震荡初始(turbulence onset , TO)、震荡斜率(turbulence slope, TS), 并按照TO及TS的结果将HRT进行分类;测量B-型钠尿肽(B-type natriuretic peptide, BNP)水平、左室舒张末期直径(Left ventricular end diastolic dimension , LVDd)及左室射血分数(left ventricular ejection fraction , LVEF), 进行两组间的比较。结果 ICM组患者TO、BNP值、LVDd值高于对照组, 而TS值、LVEF值均低于对照组, 差异均有统计学意义(P＜0.05)。与心功能Ⅳ级患者比较, 心功能Ⅱ级及心功能Ⅲ级患者TS值、BNP值、LVDd值、LVEF值差异均有统计学意义(P＜0.05)。与心功能Ⅲ级患者比较, 心功能Ⅱ级患者TS值、BNP值、LVEF值差异均有统计学意义(P＜0.05)。TS与LVEF呈正相关, 与LVDd、BNP呈负相关(P＜0.01);TO与BNP呈正相关(P＜0.05), 而TO与LVEF及LVDd的相关性无统计学意义(P>0.05)。NYHA Ⅳ级患者HRT1/2比例明显高于NYHA Ⅱ/Ⅲ(P＜0.05)。结论 ICM患者心功能越差, HRT减弱越明显, 量化HRT参数联合LVEF有助于预测ICM患者的死亡风险。
Abstract
Objective To investigate the relationship between heart rate oscillation (HRT) and heart function in ischemic cardiomyopathy patients. Methods From June 2008 to December 2012, a total of 96 ischemic myocardiopathy patients with moderate to severe heart failure patients and 75 controls were enrolled in this study. According to the New York Heart Association (NYHA) classification, these patients were divided into gradeⅡ, grade Ⅲ and grade Ⅳ subgroups. We obtained 24-hour Holter ECG records to assess the HRT parameters, including turbulence onset (TO), turbulence slope (TS), and then divided patients into three groups:HRT0, HRT1, HRT2. The value of B-type natriuretic peptide (BNP), left ventricular end diastolic dimension (LVDd), and left ventricular ejection fraction (LVEF) were measured. The relationships between HRT parameters and severity of heart failure in ischemic cardiomyopathy patients were determed. Results ICM patients had higher value of TO , BNP and LVDd than controls, but the TS and LVEF values in ICM patients were lower than those in the control group(P<0.05). There were statistical differences in TS, BNP, LVDd and LVEF between the NYHA grade Ⅳ group and NYHA grade Ⅱ/Ⅲ group(P<0.05). Significant differences in TS, BNP and LVEF between patients with NYHA grade Ⅲ and NYHA grade Ⅱ were also found(P<0.05). Correlation analyses indicated that TO positively correlated with BNP, while TS positively correlated with LVEF and negtively correlated with LVDd and BNP. ICM patients with NYHA grade Ⅳ had higher HRT1/2 rate than those with NYHA grade Ⅱ/Ⅲ(P<0.05). Conclusions HRT levels may be closely related to the development and progression of ICM in patients.
关键词
窦性心律震荡 /
缺血性心肌病 /
NYHA心功能分级
Key words
heart rate turbulence /
ischemic cardiomyopathy /
NYHA
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参考文献
[1] Verrier R L, Tan A. Heart rate, autonomic markers, and cardiac mortality[J]. Heart Rhythm, 2009, (11 Suppl):S68-75.
[2] Schmidt G, Malik M, Barthel P, et al. Heart-rate turbulence after ventricular premature beats as a predictor of mortality after acute myocardial infarction[J]. Lancet, 1999, 353(9162):1390-1396.
[3] La Rovere M T, Maestri R, Pinna G D, et al. Clinical and haemodynamic correlates of heart rate turbulence as a non-invasive index of baroreflex sensitivity in chronic heart failure[J]. Clin Sci (Lond), 2011, 121(6):279-284.
[4] Sredniawa B, Cebula S, Kowalczyk J, et al. Heart rate turbulence for prediction of heart transplantation and mortality in chronic heart failure[J]. Ann Noninvasive Electrocardiol, 2010, 15(3):230-237.
[5] Harris P R, Stein P K, Fung G L, et al. Prognostic value of heart rate turbulence for risk assessment in patients with unstable angina and non-ST elevation myocardial infarction[J].Vasc Health Risk Manag, 2013, 9:465-473.
[6] Trzos E, Krzeminska-Pakula M.Heart rate turbulence in patients with chronic heart failure[J].Kardiol Pol, 2008, 66(11):1183-1190.
[7] Bauer A, Kantelhardt J W, Barthel P, et al. Deceleration capacity of heart rate as a predictor of mortality after myocardial infarction: cohort study[J]. Lancet, 2006, 367(9523):1674-1681.
[8] Cygankiewicz I, Zareba W, Vazquez R, et al. Relation of heart rate turbulence to severity of heart failure[J]. Am J Cardiol, 2006, 98(12):1635-1640.
[9] 张 贤, 骆 锋, 刘卫涛, 等.T波电交替测定及其对预防性植入心脏除颤器的预测价值[J].山东医药, 2011, 51(13):108-109.
[10] udryński K, Strumi｜/｜/o P, Ruta J. Computer software tool for heart rate variability (HRV), T-wave alternans (TWA) and heart rate turbulence (HRT) analysis from ECGs[J]. Med Sci Monit, 2011, 17(9):MT63-71.
[11] Zuern C S, Barthel P, Bauer A. Heart rate turbulence as risk-predictor after myocardial infarction[J]. Front Physiol, 2011, 2:99.
[12] Buxton A E. Risk stratification for sudden death: do we need anything more than ejection fraction[J]. Card Electrophysiol Rev, 2003, 7(4):434-437.
[13] 梁 峰, 胡大一, 沈珠军. 2012年美国心脏病学院基金会/美国心脏协会/美国心脏节律协会(ACCF/AHA/HRS)关于置入型心脏转复除颤器(ICD)的治疗指南[J]. 医学研究杂志, 2013, 42(12):136-139.
