目的 探讨冠心病伴慢性心力衰竭(CHF)患者的心率变异性特点,并分析其与病情严重程度的相关性。方法 回顾性分析我院2022-01至2024-05收治的84例冠心病患者的临床资料,依据是否合并CHF分为两组,其中单纯冠心病患者42例(冠心病组)、冠心病伴CHF患者42例(冠心病伴CHF组),以同期到院的42例健康体检者为对照组,采用24 h动态心电图监测,观察心率变异性指标及其与病情严重程度的关系。结果 冠心病伴CHF组、冠心病组窦性心律 R-R 间期标准差(SDNN)、相邻窦性R-R间期差值的均方根(rMMD)、相邻窦性 R-R 间期差值≥50 ms占窦性心律的百分比(PNN50)、窦性R-R间期总数与窦性 R-R 间期直方图的高度之比(TRI)、最快心率低于对照组,且冠心病伴CHF组SDNN、rMMD、PNN50、TRI高于冠心病组(P＜0.05);依据美国纽约心脏病协会(NYHA)分级评估,冠心病伴CHF患者多为轻度心功能损伤,占比为40.48%,其次为中度与重度心功能损伤。Ⅳ级患者的SDNN、rMSSD、PNN50、TRI低于Ⅱ级、Ⅲ级,且Ⅲ级患者各指标低于Ⅱ级(P＜0.05);Pearson相关性分析,NYHA分级与患者心率变异性指标呈负相关(P＜0.05)。结论 冠心病或冠心病伴CHF患者均存在心脏自主神经功能减退及心率变异性降低,并伴有不同程度心功能损伤,且心率变异性指标同NYHA呈负相关。

Objective To explore the characteristics of heart rate variability in patients with coronary heart disease (CHD) accompanied by chronic heart failure (CHF) and analyze its correlation with the severity of the disease. Methods The clinical data of 84 patients with coronary heart disease in Traditional Chinese Medicine Hospital of Changsha from January 2022 to May 2024 were retrospectively analyzed and divided into two groups based on whether they had CHF or not, including 42 patients with CHD alone (CHD group) and 42 patients with CHD accompanied by CHF (CHD accompanied by CHF group), while 42 healthy subjects admitted to the same hospital during the same period were used as control group, and 24-hour holter electrocardiogram was used to observe heart rate variability indicators and its correlation with the severity of the disease. Results The standard deviation of R-R intervals (SDNN), root mean square of adjacent sinus R-R interval difference (rMMD), percentage of sinus rhythm with adjacent sinus R-R interval difference ≥ 50 ms (PNN50), ratio of total sinus R-R intervals to the height of sinus R-R interval histogram (TRI), and fastest heart rate in the CHD accompanied by CHF group were lower than those in the control group. In addition, the SDNN, root mean square of adjacent sinus R-R interval difference (rMMD), PNN50, and TRI in the CHD accompanied by CHF group were higher than those in the CHD group (P<0.05). According to New York Heart Association (NYHA) grading system, patients with CHD accompanied by CHF were mostly diagnosed with mild heart function impairment, accounting for 40.48%, followed by moderate to severe heart function impairment. SDNN, rMSSD, PNN50, and TRI of grade IV patients were lower than those of grade Ⅱ and Ⅲ, and all indicators of grade Ⅲ patients were lower than those of grade Ⅱ (P<0.05). Pearson correlation analysis showed a negative correlation (P<0.05) between NYHA grade and heart rate variability indicators. Conclusions Patients with CHD or with CHD accompanied by CHF exhibit cardiac autonomic dysfunction and decreased heart rate variability, accompanied by different degrees of cardiac function impairment, and the indicators of heart rate variability is negatively correlated with NYHA.