非EF值降低心力衰竭患者心率变异性特征分析
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摘要
目的分析非EF值降低心力衰竭(HF)患者心率变异性(HRV)特征。方法回顾性分析2015年8月至2018年8月间在镇安县医院心血管内科接受治疗的慢性心力衰竭(CHF)患者240例,依据患者左室射血分数(LVEF)状况分成两组,LVEF<40%者为EF值下降组(90例),LVEF≥40%者为非EF值下降组(150例),同时选取在本院体检的健康者100例作为对照组,记录三组受检者的年龄、性别等一般资料和生化指标[包含谷丙转氨酶、空腹血糖、低密度胆固醇(LDL-C)、胆固醇(TC)、甘油三酯等],入院3 d内完善超声心动图和24 h动态心电图,记录其HRV值,包含低频/高频(LF/HF)、正常全部相邻窦性心跳QRS波群的间期(RR)间期标准差(SDNN)、高频(HF)、5 min均值标准差(SDANN)、LF、5 min标准差的平均值(SDNNindex)、24 h频域功率、RR间期之差均方根(rMSSD)、相邻RR间期相差>50 ms的个数除以RR间期总数百分比(pNN50),并对三组受检者的上述观察指标做统计分析。结果非EF值下降组患者的SDNN、SDANN分别为(95.91±15.36) ms、(80.19±11.54) ms,EF值下降组患者的SDNN、SDANN分别为(68.69±15.14) ms、(51.83±11.68) ms,均比对照组的(143.86±15.27) ms、(132.50±11.67) ms明显降低,且EF值下降组患者降低程度高于非EF值下降组,差异均有统计学意义(P<0.05);EF值下降组患者SDNNindex为(45.30±6.21) ms,低于非EF值下降组的(56.25±6.30) ms和对照组的(58.10±6.79) ms,差异有统计学意义(P<0.05);非EF值下降组患者24 h频域功率为(1 570.22±371.08) ms2,EF值下降组患者24 h频域功率为(1 620.59±368.54) ms2,均比对照组的(3 230.17±367.42) ms2明显降低,差异有统计学意义(P<0.05)。结论非EF值下降患者其机体内已存在自主神经功能损伤,HRV降低可作为对HFpEF/HFmrEF前期识别的重要线索。
Objective To analyze the heart rate variability(HRV) characteristics in heart failure patients(HF with non-EF values reduction. Methods A retrospective analysis was performed for 240 patients with chronic heart failure(CHF) who were treated in the Department of Cardiology at Zhen'an County Hospital from August 2015 to August2018. They were divided into two groups according to the left ventricular ejection fraction(LVEF) status of patients: EF value descending group(LVEF<40%, 90 cases) and non-EF value reduction group(LVEF≥40%, 150 cases). At the same time, 100 healthy subjects who underwent physical examination in our hospital were selected as the control group.The general data(such as age and gender) and biochemical indicators(including alanine aminotransferase, fasting blood glucose, low-density lipoprotein cholesterol [LDL-C], total cholesterol [TC], triglycerides) of the three groups were recorded. Echocardiography and 24 h dynamic electrocardiograms were improved within 3 days of admission. The HRV values were record, including low frequency/high frequency(LF/HF), standard deviation of the NN(R-R) intervals(SDNN), high frequency(HF), standard deviation of sequential five-minute R-R interval means(SDANN), LF, mean of SDNN for all consecutive 5-minute segments of the recording(SDNNindex), 24 h frequency domain power, root mean square of successive RR interval differences(rMSSD), and percentage of adjacent NN intervals differing by more than50 ms(pNN50). Statistical analysis was performed on the above observations of the three groups. Results The SDNN and SDANN of patients with non-EF reduction were(95.91±15.36) ms and(80.19±11.54) ms, respectively. The SDNN and SDANN of patients with EF descending were(68.69±15.14) ms and(51.83±11.68) ms, respectively. Compared with(143.86±15.27) ms and(132.50±11.67) ms in the control group, both corresponding data were significantly decreased,and the degree of reduction in the EF value descending group was higher than that in the non-EF value reduction group(P<0.05). The SDNNindex of the patients with decreased EF was(45.30 ± 6.21) ms, which was lower than(56.25±6.30) ms of the non-EF value reduction group and(58.10±6.79) ms of the control group(P<0.05). The 24 h frequency domain power was(1 570.22±371.08) ms2 in the non-EF value reduction group, and that was(1 620.59±368.54)ms2 in the EF value descending group, which were both significantly lower than(3 230.17±367.42) ms2 in the control group(P<0.05). Conclusion Patients with non-EF values reduction have autonomic nerve damage in their bodies. The reduction of HRV can be used as an important clue for early recognition of HFpEF/HFmrEF.
Objective To analyze the heart rate variability(HRV) characteristics in heart failure patients(HF with non-EF values reduction. Methods A retrospective analysis was performed for 240 patients with chronic heart failure(CHF) who were treated in the Department of Cardiology at Zhen'an County Hospital from August 2015 to August2018. They were divided into two groups according to the left ventricular ejection fraction(LVEF) status of patients: EF value descending group(LVEF<40%, 90 cases) and non-EF value reduction group(LVEF≥40%, 150 cases). At the same time, 100 healthy subjects who underwent physical examination in our hospital were selected as the control group.The general data(such as age and gender) and biochemical indicators(including alanine aminotransferase, fasting blood glucose, low-density lipoprotein cholesterol [LDL-C], total cholesterol [TC], triglycerides) of the three groups were recorded. Echocardiography and 24 h dynamic electrocardiograms were improved within 3 days of admission. The HRV values were record, including low frequency/high frequency(LF/HF), standard deviation of the NN(R-R) intervals(SDNN), high frequency(HF), standard deviation of sequential five-minute R-R interval means(SDANN), LF, mean of SDNN for all consecutive 5-minute segments of the recording(SDNNindex), 24 h frequency domain power, root mean square of successive RR interval differences(rMSSD), and percentage of adjacent NN intervals differing by more than50 ms(pNN50). Statistical analysis was performed on the above observations of the three groups. Results The SDNN and SDANN of patients with non-EF reduction were(95.91±15.36) ms and(80.19±11.54) ms, respectively. The SDNN and SDANN of patients with EF descending were(68.69±15.14) ms and(51.83±11.68) ms, respectively. Compared with(143.86±15.27) ms and(132.50±11.67) ms in the control group, both corresponding data were significantly decreased,and the degree of reduction in the EF value descending group was higher than that in the non-EF value reduction group(P<0.05). The SDNNindex of the patients with decreased EF was(45.30 ± 6.21) ms, which was lower than(56.25±6.30) ms of the non-EF value reduction group and(58.10±6.79) ms of the control group(P<0.05). The 24 h frequency domain power was(1 570.22±371.08) ms2 in the non-EF value reduction group, and that was(1 620.59±368.54)ms2 in the EF value descending group, which were both significantly lower than(3 230.17±367.42) ms2 in the control group(P<0.05). Conclusion Patients with non-EF values reduction have autonomic nerve damage in their bodies. The reduction of HRV can be used as an important clue for early recognition of HFpEF/HFmrEF.
引文
[1]赵莉,孙红梅.左西孟旦对失代偿期心力衰竭患者心率变异性血流动力学及B型利钠肽水平的影响[J].安徽医学, 2017, 38(3):348-350.
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[10]陶贞竹,欧柏青,邓婷智.慢性心衰患者不同时间心率变异性与短阵室速的相关性研究[J].医学临床研究, 2017, 34(4):637-640.
[11] Soylu MO, Altun I, Basaran O, et al. Impact of QRS morphology on heart rate turbulence and heart rate variability after cardiac resynchronization therapy in patients with heart failure[J]. Eur Rev Med Pharmacol Sci, 2016, 20(2):317-320.
[12]蓝韶仁,李晓燕,李福兴.慢性心力衰竭患者心率变异性与超敏C反应蛋白及心功能的关系[J].中国病案, 2018, 13(7):219-223.
[13] KAZMI SZ, ZHANG H, AZIZ W, et al. Inverse correlation between heart rate variability and heart rate demonstrated by linear and nonlinear analysis[J]. PLoS One, 2016, 11(6):557-560.
[14]吴坤生.心率变异性与心力衰竭病人房性心律失常发生的关系探讨[J].中西医结合心脑血管病杂志, 2016, 14(3):293-296.
[15]师幸伟,杨波,芦兰,等.心率减速力评估慢性充血性心力衰竭患者自主神经失衡的价值[J].广东医学, 2016, 37(16):2419-2421.
[16]刘性涛.新活素对老年慢性心力衰竭合并糖尿病患者心率变异性的影响分析[J].中国心血管病研究, 2017, 15(2):169-173.
[2]刘红朵儿,彭屹,孙兴国.基于动态心电图数据的充血性心力衰竭患者心率变异性分析[J].中国循环杂志, 2016, 31(1):140-141.
[3] BULLINGA JR, ALHARETHI R, SCHRAM MS, et al. Changes in heart rate variability are correlated to hemodynamic improvement with chronic CARVEDILOL therapy in heart failure[J]. J Card Fail,2016, 11(9):693-699.
[4]徐琴,杨琴,胡德成. QT离散度、心率变异性、脉搏波传导速度在心力衰竭患者中的应用价值[J].海南医学, 2017, 28(23):3807-3809.
[5]曾学寨,刘德平. 2016年欧洲心脏病协会心力衰竭指南解读[J].中国心血管杂志, 2016, 21(5):355-358.
[6]温清艳,区浩林,孙巧松,等.帕金森伴慢性心力衰竭患者心率变异性的变化特点及其与心功能指标和预后的关系[J].广东医学,2017, 11(22):3485-3487.
[7] PATEL VN, PIERCE BR, BODAPATI RK, et al. Association of holter-derived heart rate variability parameters with the development of congestive heart failure in the cardiovascular health study[J]. Jacc Heart Failure, 2017, 5(6):423-426.
[8]刘玉,周利民,张军.心率变异性对慢性心力衰竭病情评估及预后的应用价值[J].新疆医科大学学报, 2018, 5(3):291-294.
[9]才让卓玛,刘建菊.高海拔地区心力衰竭患者心率变异性与脑钠肽相关性分析[J].检验医学与临床, 2018, 9(1):58-60.
[10]陶贞竹,欧柏青,邓婷智.慢性心衰患者不同时间心率变异性与短阵室速的相关性研究[J].医学临床研究, 2017, 34(4):637-640.
[11] Soylu MO, Altun I, Basaran O, et al. Impact of QRS morphology on heart rate turbulence and heart rate variability after cardiac resynchronization therapy in patients with heart failure[J]. Eur Rev Med Pharmacol Sci, 2016, 20(2):317-320.
[12]蓝韶仁,李晓燕,李福兴.慢性心力衰竭患者心率变异性与超敏C反应蛋白及心功能的关系[J].中国病案, 2018, 13(7):219-223.
[13] KAZMI SZ, ZHANG H, AZIZ W, et al. Inverse correlation between heart rate variability and heart rate demonstrated by linear and nonlinear analysis[J]. PLoS One, 2016, 11(6):557-560.
[14]吴坤生.心率变异性与心力衰竭病人房性心律失常发生的关系探讨[J].中西医结合心脑血管病杂志, 2016, 14(3):293-296.
[15]师幸伟,杨波,芦兰,等.心率减速力评估慢性充血性心力衰竭患者自主神经失衡的价值[J].广东医学, 2016, 37(16):2419-2421.
[16]刘性涛.新活素对老年慢性心力衰竭合并糖尿病患者心率变异性的影响分析[J].中国心血管病研究, 2017, 15(2):169-173.