急性冠脉综合征患者窦性心率震荡与心功能的关系分析

摘要

AIM:To investigate the relations between heart rate turbulence and heart function in patients with the acute coronary syndrome (ACS).METHODS:A total of 83 cases of hospital-ized patients with ventricular premature beat were selected.A-mong them,5 1 cases diagnosed with ACS were included in the observation group,which was further divided into two subgroups according to ejection fraction:patients with normal heart function (21 cases)and patients with abnormal heart function (30).The other 32 without c and other organic heart diseases were included in the control group.Twenty-four hours dynamic electrocardio-gram,turbulence onset (TO)and turbulence slope (TS)as well as its relationship with left ventricular ejection fraction (LVEF ) were compared.The value of TO and T-S in groups were com-pared,and analyze the HRT and the heart function relations.RE-SULTS:The difference of TO between the control group and ACS group with normal heart function was not of statistically signifi-cance (P>0.05).TO of the control group was lower than ACS group with abnormal heart function,and the difference was of sta-tistically significance (P<0.05 ).TS of the control group was higher than that of ACS group with normal heart function (P<0.05)and with abnormal heart function (P <0.01 ),and the differences were statistically significant;TS of ACS group with normal heart function was higher than that of the ACS group with abnormal heart function,and the difference was of statistically sig-nificant (P<0.05 ).There was no obvious relationship between TO and LVEF (r=-0.146,P>0.05 );TS and LVEF were positively correlated (r=0.481,P<0.01).CONCLUSION:Nonfatal heart attacks increase the mortality of patients,and HRT may serve as a reliable indicator for evaluating prognosis of ACS. Severe myocardial ischemia can decrease or eliminate the HRT. TS was more sensitive to myocardial ischemia.HRT_2 is the iso-lated indicator for patients with a high risk of developing ACS, and its indicating ability is superior to other risk factors in this study.To and TS are mutually independent,they are of different values in predicting,and TS is superior.Critical myocardial is-chemia could weaken HRT in ACS patient,HRT weakens along with heart function's drop,and TS and LVEF has strong correla-tion.%目的：探讨急性冠脉综合征（ACS）患者窦性心率震荡（HRT）与心功能的关系．方法：选择我院83例伴有室性早搏的住院病人，其中51例确诊为急性冠脉综合征，作为观察组；32例排除急性冠脉综合征及其他器质性心脏疾病，作为对照组．另外，观察组根据射血分数，再分为心功能正常组（2 1例）和心功能不全组（30例），均记录24 h动态心电图，计算其震荡起始（TO）和震荡斜率（TS），并与心功能（LVEF）的关系进行直线相关分析．结果：对照组震荡起始（TO ）与急性冠脉综合征心功能正常组的差异无统计学意义（P＞0．05），震荡起始（TO）显著低于急性冠脉综合征心功能不全组，差异显著，具有统计学意义（P＜0．01），急性冠脉综合征心功能正常组震荡起始（TO ）与心功能不全组的差异无统计学意义（P＞0．05）．对照组震荡斜率（TS）高于急性冠脉综合征心功能正常组（P＜0．05）与心功能不全组（P＜0．01），差异有统计学意义；急性冠脉综合征心功能正常组震荡斜率（TS ）高于心功能不全组，差异有统计学意义（P＜0．05）．震荡起始（TO）与左室射血分数（LVEF）无明显相关性（r ＝－0．146，P ＞0．05）；振荡斜率（TS）与左室射血分数（LVEF）呈正相关（r＝0．481，P＜0．01）．结论：非致死性心脏事件危险使ACS患者死亡及非致死性心脏事件的风险增加，HRT可能是评估ACS预后的可靠指标之一．心肌严重缺血可导致ACS患者的HRT减弱或消失，TS 对严重心肌缺血更敏感．HRT2是高危 ACS患者独立预测指标，HRT2的预测能力强于本研究中的其它风险因素．TO与TS相互独立，二者对高危ACS患者的预测价值不同，TS的预测价值更高．