心率震荡对扩张型心肌病并发潜在恶性室性心律失常的预测价值  

The value of heart rate turbulence in predicting potentially malignant ventricular arrhythmia in dilated cardiomyopathy patients

作　　者：方红飞[1] 郑和豪[1] 李念[1] 

机构地区：[1]浙江省衢州市人民医院心电图室,324000

出　　处：《心电与循环》2014年第1期47-49,共3页Journal of Electrocardiology and Circulation

摘　　要：目的探讨窦性心率震荡(HRT)对扩张型心肌病并发潜在恶性室性心律失常的预测价值。方法 45例扩张型心肌病患者根据合并的良性或潜在恶性室性心律失常分为良性室性心律失常组(16例)及潜在恶性室性心律失常组(29例),30例健康体检者作为对照组,行24h动态心电图检查,计算并比较HRT的震荡初始值(TO)、震荡斜率(TS)。计算TO≥0,TS≤2.5ms/R-R、T0≥0+TS≤2.5ms/R-R的敏感度、特异度、阳'性预测值、阴性预测值。结果良性室性心律失常组及潜在恶性室性心律失常组TS[(4 68±3.87)ms/R-R,(2.48±2176)ms/R-R]显著低于对照组[(9.08±5.57)ms/R-R],TO[(-0.11±3.16)%、(1.17±2.08)%]显著高于对照组[(-2.96±3.42)%],差异均有显著统计学意义(P<0.01);潜在恶性室性心律失常组TS低于良性室性心律失常组,TO高于良性室性心律失常组,差异有统计学意义(P<0.05);TS≤2.5ms/R-R时,敏感度、特异度、阳性预测值、阴性预测值(79.37%、93 48%、88.46%及87.76%)均高于TO≥O(75.86%、82.61%、73.33%及84.44%),TO≥O+TS≤2.5ms/R-R特异度、阳性预测值(97.81%、95.24%)最高,敏感度、阴性预测值(68.97%、83.33%)最低。结论扩张型心肌病患者HRT显著变钝,TS可作为扩张型心肌病并发潜在恶性室性心律失常的预测指标。Objective. To investigate the value of heart rate turbulence （HRT） in predicting potentially malignant ventricular arrhythmia （VA） in dilated cardiomyopathy patients. Methods 45 patients with dilated cardiomyopathy were divided into benign VA group （n=16） and potentially malignant VA group （n=29）. 30 healthy individuals were included as control group. They underwent 24 h dynamic ECG examination. HRT onset（TO） and turbulence slope（TS） were calculated and compared between groups. The sensitivity, specificity, positive and negative predictive value of TO ≥0, TS ≤ 2.5ms / R-R, TO ≥0 ＋TS ≤2.5ms / R-R were analyzed. Results TS was significantly lower and TO was higher in benign VA group [（4.68 ± 3.87）%], （-0.11 ± 3.16）%] and potentially malignant VA group [（2.48 ± 2.76）%, （1.17 ± 2.08）%] than that in control group [（9.08 ＋ 5.57）%,（-2.96 ± 3.42）%]（all P〈0.01）. TS was significantly lower and TO was higher in potentially malignant VA group than in benign VA group （P〈0.05）. The sensitivity, specificity, positive and negative predictive value of TS 〈2.5ms / R-R （79.37%, 93.48%, 88.46%, 87.76%） were higher than those of TO 〉10 （75.86%, 82.61%, 73.33%, 84.44%）, respectively. The combination of TO ≥0 and TS≤2.5ms / R-R yielded the highest specificity and positive predictive value, but the lowest sensitivity and negative predictive value. Conclusion HRT is impaired in dilated cardiomyopathy patients. TS may be a predictor of potentially malignant VA in patients with dilated cardiomyopathy.

关 键 词：窦性心率震荡 扩张型心肌病 室性心律失常 

分 类 号：R541.7[医药卫生—心血管疾病]