扩张型心肌病患者心率变异性及左心室重构与室性心律失常的关系  

Relationships between heart rate variability,left ventricular remodeling and ventricular arrhythmia in patients with dilated cardiomyopathy

作　　者：梁见弟[1] 叶继亮[1] 姚永钊 李晓媚 LIANG Jian-di;YE Ji-liang;YAO Yong-zhao;LI Xiao-mei(Department of Internal Medicine-Cardiovascular,Dongguan People′s Hospital,Dongguan,Guangdong 523000,China)

机构地区：[1]东莞市人民医院心血管内科,广东东莞523000

出　　处：《岭南心血管病杂志》2022年第4期318-322,共5页South China Journal of Cardiovascular Diseases

基　　金：2019年东莞市社会科技发展(一般)项目(项目编号:201950715001860)。

摘　　要：目的探讨扩张型心肌病(dilated cardiomyopathy,DCM)患者心率变异性(heart rate variability,HRV)及左心室重构与室性心律失常(ventricular arrhythmia,VA)的关系。方法回顾性分析2017年1月至2017年12月东莞市人民医院连续收治的80例DCM患者(DCM组)的临床资料,根据其VA发生情况,分为VA亚组(n=25)和非VA亚组(n=55)。并回顾性选取同期体检正常者30名为对照。收集并比较DCM组两个亚组患者入院24 h内的美国心脏病协会心功能(New York Heart Association,NYHA)分级及随访期间心血管事件(急性心力衰竭、急性心肌梗死、心源性猝死)发生率。比较3组研究对象24 h全部正常心动周期的标准差(standard deviation of all normal cardiac cycles,SDNN)、每5 min RR间期标准差(standard deviation of RR intervals every 5 min,SDANN)、差值均方根(root mean square of difference,RMSSD)、相邻RR间期相差大于50 ms计数占总窦性心博的百分比(the percentage of counts in total sinus beats between adjacent RR intervals of more than 50 ms,PNN50)、低频段功率(low-frequency power,LF)、高频段功率(high frequency power,HF)等HRV指标。并比较3组研究对象的左心室舒张末期容积(left ventricular diastolic volume,LVEDV)、左心室射血分数(left ventricu⁃lar ejection fraction,LVEF)、左心室短轴缩短率(left ventricular short axis shortening rate,FS%)等左心室重构相关指标。采用线性回归模型分析DCM患者HRV及左心室重构对VA的影响。结果VA亚组患者NYHA心功能分级为Ⅲ级的患者比例和心血管事件发生率均高于非VA亚组,差异有统计学意义(64.00%vs.16.36%,P<0.05;28.00%vs.3.64%,P<0.05)。三组研究对象HRV指标、FS%及LVEF比较,对照组最高,其次为非VA亚组,VA亚组患者最低,差异有统计学意义(P<0.05)。三组研究对象LVEDV比较,对照组最小,其次为非VA组,VA组患者最大,差异有统计学意义(P<0.05)。线性回归分析结果显示,HRV、LVEF、FS%、LVEDV为DCM患者VA发生�Objectives To investigate the relationships between heart rate variability(HRV),left ventricular remodel⁃ing and ventricular arrhythmia(VA)in patients with dilated cardiomyopathy(DCM).Methods The clinical data of 80 DCM patients(DCM group)continuously admitted into Dongguan People′s Hospital from January 2017 to December 2017 were retrospectively analyzed.According to their VA occurrence,they were divided into two subgroups:VA sub group(n=25)and non-VA subgroup(n=55).And 30 healthy persons with normal physical examination during the same period were retrospectively selected as control group.The New York Heart Association(NYHA)classification within 24 hours of admission and the rate of cardiovascular events(acute heart failure,acute myocardial infarction and sudden cardiac death)during the follow-up period in the two subgroups of DCM group were collected and compared.The standard deviation of all normal cardiac cycles(SDNN),standard deviation of RR intervals every 5 min(SDANN),root mean square of difference(RMSSD),the percentage of counts in total sinus beats between adjacent RR intervals of more than 50 ms(PNN50),low-frequency power(LF),high frequency power(HF)and other HRV indica⁃tors among the three groups were compared.The left ventricular diastolic volume(LVEDV),left ventricular ejection frac⁃tion(LVEF),left ventricular short axis shortening rate(FS%)and other related indicators of left ventricular remodel⁃ing among the three groups were compared.The effects of HRV and left ventricular remodeling on VA in patients with DCM were analyzed by linear regression model.Results The proportion of patients with NYHA gradeⅢand the rate of cardiovascular events in VA subgroup were significantly higher than those in non-VA subgroup(64.00%vs.16.36%,P<0.05;28.00%vs.3.64%,P<0.05).Comparing the HRV indexes,FS%and LVEF of the three groups,control group was the highest,which was followed by non-VA subgroup,and VA subgroup was the lowest(P<0.05).Comparing LVEDV of the three groups,control group was the smallest,whic

关 键 词：扩张型心肌病 心率变异性 左心室重构 室性心律失常 关系 

分 类 号：R542.2[医药卫生—心血管疾病]