心率震荡对慢性心力衰竭患者预后的预测价值

摘要

Objective To evaluate the prognostic significance of heart rate turbulence ( HRT ) for predicting readmis-sion and mortality rate in chronic heart failure ( CHF ) patients in NYHA class II ~ IV. Methods 104 patients with CHF and 30 normal controls were enrolled in present study, HRT ( TO and TS ), left ventricular ejection fraction ( LVEF ), left ventricular end diastolic diameter ( LVEDD ), resting heart rate ( RHR ), SDNN were recorded. Patients were followed up for 6 ~ 18 months, the end point were readmission and cardiac death. Results Univariate analysis showed that age≥65years, LVEF≤ 30% , SDNN ≤ 100ms, RHR ≥75bpm, HRT1, HRT2 could predict the end point, HRT2 was the strongest predictor ( RR = 5.40, P < 0. 05 ); Multivariate analysis showed that only LVEF ≤ 30% ( RR = 4. 68 , P < 0. 05 ), RHR ≥5 75bpm ( RR = 3.18, P <0.05 ), SDNN≤ l00 ms ( RR =3.69, P <0.05 ) and HRT2 ( RR = 5.12, P <0.05 ) had prognostic value to the end point. Conclusion HRT is a powerful predictor for heart failure in CHF patients with class II ~ IV.%目的 探讨心率震荡(HRT)对慢性心力衰竭(CHF)患者预后的预测价值.方法 观察记录104例 CHF患者和30例正常对照者的 HRT(TO和 TS)、左室射血分数(LVEF)、左室舒张末内径(LVEDD)、静息心率(RHR)、SDNN,随访6～18个月,终点事件是患者心力衰竭恶化入院、心源性死亡.结果 单变量分析结果表明,年龄≥65岁、LVEF≤30%、SDNN≤100 ms、RHR≥75 次/min、HRT 1、HRT 2等6个变量对终点事件有预测价值,其中 HRT 2具有最强的预测意义( RR=5.40,P<0.05);多变量分析结果显示 LVEF≤30%( RR=4.68,P<0.05)、RHR≥75 次/min(RR=3.18,P<0.05)、SDNN≤100 ms( RR=3.69,P<0.05)、HRT 2( RR=5.12,P<0.05)为仅有的4个对终点事件有预测价值的变量.结论 HRT是心功能II~IV级心力衰竭患者一个有力的预后预测因子.