开通冠状动脉慢性完全闭塞病变对患者心率震荡的影响  

Influence of open coronary artery chronic total occlusion lesion on heart rate turbulence

作　　者：赵江峰[1] 杨超前 安明春 畅晓燕[2] Zhao Jiangfeng;Yang Chaoqian;An Mingchun;Chang Xiaoyan(Department of Cardiology,the First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471003,China;Department of Cardiology,the Second Affiliated Hospital of Henan University of Science and Technology,Luoyang 471000,China)

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,洛阳471000

出　　处：《中国心血管杂志》2023年第3期241-245,共5页Chinese Journal of Cardiovascular Medicine

摘　　要：目的探讨开通冠状动脉慢性完全闭塞病变(CTO)患者窦性心率震荡(HRT)的变化。方法单中心回顾性研究。连续入选2018年9月至2021年9月在河南科技大学第一附属医院住院治疗的260例CTO患者,根据血管是否开通,分为开通组219例与非开通组41例;另外选取同期住院的无心肌缺血和器质性心脏病变的40例患者为对照组。行24 h动态心电图检查,计算HRT指标:震荡初始值(TO)和震荡斜率(TS);行超声心动图检查,测定评价心功能的相关指标。比较CTO组与对照组的HRT差异;并于3个月后复查上述指标,比较开通组与非开通组的HRT差异、开通前与开通后的HRT变化。结果与对照组比较,CTO组TO明显升高(0.31%±2.12%比-2.38%±2.53%,t=9.089,P=0.023),TS明显降低[(0.35±2.73)ms/RRI比(5.93±2.78)ms/RRI,t=5.542,P=0.017]。3个月后,与非开通组比较,开通组TO下降不明显(-0.16%±1.08%比0.35%±1.93%,t=2.412,P=0.059),而TS有明显回升[(3.98±2.45)ms/RRI比(0.10±1.28)ms/RRI,t=9.897,P=0.015];与开通前比较,开通后TO下降(-0.16%±1.08%比0.33%±1.67%,t=3.662,P=0.042),TS回升[(3.98±2.45)ms/RRI比(0.57±1.53)ms/RRI,t=17.487,P=0.039],左心室射血分数升高(50.31%±2.12%比44.86%±1.83%,t=28.770,P=0.043),左心室舒张末期内径变化不明显。结论CTO患者HRT现象明显受损,心脏自主神经调节功能下降;开通闭塞血管后HRT现象恢复,心功能改善,自主神经功能恢复。Objective To investigate the changes of heart rate turbulence(HRT)in patients with open coronary artery chronic total occlusion(CTO).Methods This was a single center retrospective study.A total of 260 CTO patients,including 176 males and 84 females,with an average age of(64.8±5.3)years,were selected as CTO group.According to whether the vessels were recanalization or not,the CTO group was divided into recanalization group(219 cases)and non-recanalization group(41 cases).Another 40 normal subjects,including 24 males and 16 females,with an average age of(61.6±6.0)years,were selected as the control group.24 h Holter examination was performed,and HRT parameters were calculated,including turbulence onset(TO)and turbulence slope(TS).Echocardiography was performed to measure the related indexes of cardiac function.The difference of HRT between CTO group and control group was compared.All patients were reexamined 3 months later,and the HRT differences between the recanalization group and the non-recanalization group,and the changes of HRT before and after the recanalization were compared.Results Compared with the control group,the CTO group had significantly higher TO(0.31%±2.12%vs.-2.38%±2.53%,t=9.089,P=0.023),and significantly lower TS[(0.35±2.73)ms/RRI vs.(5.93±2.78)ms/RRI,t=5.542,P=0.017].After 3 months,compared with the non-recanalization group,the TO decreased not significantly(-0.16%±1.08%vs.0.35%±1.93%,t=2.412,P=0.059),while the TS increased significantly[(3.98±2.45)ms/RRI vs.(0,10±1.28)ms/RRI,t=9.897,P=0.015]in the recanalization group.Compared with before recanalization,TO declined(-0.16%±1.08%vs.0.33%±1.67%,t=3.662,P=0.042),TS recovery[(3.98±2.45)ms/RRI vs.(0.57±1.53)ms/RRI,t=17.487,P=0.039],and LVEF increased(50.31%±2.12%vs.44.86%±1.83%,t=28.770,P=0.043),while LVEDD did not change significantly after recanalization of CTO vessels.Conclusions HRT is obviously impaired in CTO patients,and cardiac autonomic nerve regulation function is decreased.After reopening the occluded vessels,HRT is recover

关 键 词：冠状动脉闭塞 慢性完全闭塞病变 心率震荡 心脏自主功能 冬眠心肌 

分 类 号：R541.4[医药卫生—心血管疾病]