左心室射血分数保留的心力衰竭患者心率震荡的临床意义研究  

Clinical significance of heart rate turbulence in heart failure patients with preserved ejection fraction

作　　者：赵江峰[1] 董平栓[1] 曲红培[1] 李艳云[1] 畅晓燕[2] 

机构地区：[1]河南科技大学第一附属医院心内科,洛阳471003 [2]河南科技大学第二附属医院心内科

出　　处：《中华老年心脑血管病杂志》2016年第7期681-683,共3页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的研究左心室射血分数保留的心力衰竭(heart failure with preserved ejection fraction,HFPEF)患者窦性心率震荡(heart rate turbulence,HRT)的变化以及临床意义。方法选择52例在河南科技大学第一附属医院接受治疗的HFPEF患者作为HEPEF组,另选择无心肌缺血及器质性心脏病变患者30例作为对照组。行24h动态心电图检查,计算HRT指标:震荡初始值(turbulence onset,TO)和震荡斜率(turbulence slope,TS)。行超声心动图检查测定评价心功能不全的相关指标,比较HFPEF组与对照组之间HRT的差异。结果与对照组比较,HFPEF组TO明显升高[(0.17±1.40)%vs(-0.26±0.99)%,P=0.027],TS明显降低[(0.88±2.51)ms/RRI vs(2.60±2.76)ms/RRI,P=0.003]。Pearson相关性分析显示左心室舒张末期容积指数与TO负相关(r=-0.55,P=0.01),与TS呈正相关(r=0.23,P=0.03);舒张早期二尖血流速度和二尖瓣环运动速度比值与TO正相关(r=0.21,P=0.04),与TS呈负相关(r=-0.39,P=0.01)。结论 HFPEF患者窦性心率震荡现象明显受损,提示心脏自主神经调节功能下降,并且反映左心室舒张功能。Objective To study the change of heart rate turbulence（HRT）in heart failure patients with preserved ejection fraction（HFPEF）and its clinical significance.Methods Fifty-two patients with HFPEF served as a HFPEF group and 30 patients with no myocardium ischemia and organic heart disease served as a control group in this study.They underwent 24 hambulant ECG to calculate their turbulence onset（TO）and turbulence slope（TS）values and underwent ultrasound cardiogram to assess their cardiac function and compare their HRT.Results The TO was significantly higher whereas the TS was significantly lower in HFPEF group than in control group（0.17%±1.40% vs-0.26% ±0.99%,P=0.027;0.88±2.51 ms/RRI vs 2.60±2.76ms/RRI,P=0.003）.Pearson correlation analysis showed that the EDVI of left ventricle was negatively correlated with TO and positively correlated with TS（r=-0.55,P=0.01;r=0.23,P=0.03）,and the ratio of early diastolic transmitral blood flow speed/early diastolic mitral annular blood flow speed was positively correlated with TO and negatively correlated with TS.ConclusionThe significant damage of HRT in HF patients with PEF indicates that the reduced autonomic neuroregulation function of heart reflects the diastolic function of left ventricule.

关 键 词：心室功能 左 每搏输出量 心力衰竭 心率 

分 类 号：R541.6[医药卫生—心血管疾病]