心率变异性联合超声心动图对射血分数保留型心力衰竭的临床价值  

Clinical value of heart rate variability and echocardiography on heart failure patients with preserved ejection fraction

作　　者：徐良洁[1] 王春靓[1] 周翠翠[1] 梁仪[1] Xu Liang-jie;Wang Chun-liang;Zhou Cui-cui;Liang Yi(Department of Cardiology,Affiliated Hospital of Jiangsu University,Zhenjiang Jiangsu 212001,China)

机构地区：[1]江苏大学附属医院心内科,江苏镇江212001

出　　处：《实用心电学杂志》2020年第5期313-318,共6页Journal of Practical Electrocardiology

基　　金：江苏省卫生健康委医学科研项目(H2019075);镇江市重点研发计划(社会发展)项目(SH2019087)。

摘　　要：目的探讨心率变异性联合超声心动图对射血分数保留型心力衰竭进行诊断和预后评估的临床价值。方法选取144例左室射血分数正常的患者,行24 h动态心电图及常规超声心动图检查。根据超声心动图结果将患者分成左室舒张功能不全(left ventricular diastolic dysfunction,LVDD)组(LVDD组,76例)和左室舒张功能(left ventricular diastolic function,LVDF)正常组(LVDF正常组,68例),运用受试者工作特征曲线,分析心率变异性对左室舒张功能不全的诊断意义,并对主要终点事件进行随访。结果心率变异性参数中,24 h内窦性心搏RR间期的标准差(standard deviation of NN intervals,SDNN)预测左室舒张功能不全的曲线下面积最大(AUC=0.827,P<0.01),cut-off值为92 ms。根据cut-off值,进一步将LVDD组分为低SDNN组(cut-off值<92 ms,40例)和高SDNN组(cut-off值≥92 ms,36例)。生存曲线显示,低SDNN组的心脏不良事件发生率和全因死亡率较高SDNN组显著升高(P<0.05)。结论SDNN可作为左室舒张功能障碍患者临床诊断及预后评估的敏感指标。Objective To explore the clinical value of heart rate variability(HRV)and echocardiography in making diagnosis and prognostic evaluation among heart failure patients with preserved ejection fraction.Methods A total of 144 patients with normal left ventricular ejection fraction(LVEF)underwent 24-hour ambulatory electrocardiography and routine echocardiography examinations.Patients were divided into two groups accor-ding to echocardiography results:left ventricular diastolic dysfunction(LVDD)group(LVDD group,76 cases)and normal left ventricular diastolic function(LVDF)group(normal LVDF group,68 cases).According to the receiver operating characteristic(ROC)curve,the diagnostic significance of HRV on LVDD was analyzed,and the primary endpoint events were followed up.Results Among HRV indexes,the area under curve of 24-hour standard deviation of NN intervals(SDNN)in the prediction of LVDD is the largest(AUC=0.827,P<0.01);the cut-off value is 92 ms.According to the cut-off value,the patients in LVDD group are further divided into two groups:low-SDNN group(cut-off value<92 ms,40 cases)and high-SDNN group(cut-off value≥92 ms,36 cases).The survival curve reveals that in the low-SDNN group the incidence of adverse cardiac events and total mortality are signi-ficantly higher than those in the high-SDNN group(P<0.05).Conclusion SDNN can be served as a sensitive indicator for making clinical diagnosis and prognostic evaluation among the patients with LVDD.

关 键 词：心率变异性 超声心动图 动态心电图 左室舒张功能不全 心力衰竭 

分 类 号：R540.4[医药卫生—心血管疾病] R541.6[医药卫生—内科学]