Cygankiewicz Iwona, Zareba Wojciech, de Luna Antoni Bayes
Department of Electrocardiology, Sterling Memorial University Hospital, Łódź, Poland.
Cardiol J. 2008;15(4):313-23.
Congestive heart failure (CHF) is an increasingly widespread, costly and deadly disease, frequently named as epidemics of the 21 century. Despite advancement in modern treatment, mortality rate in CHF patients remains high. Therefore, risk stratification in patients with CHF remains one of the major challenges of contemporary cardiology. Electrocardiographic parameters based on ambulatory Holter monitoring have been documented to be independent risk predictors of total mortality and progression of heart failure. Recent years brought an increased interest in evaluation of dynamic Holter-derived ECG markers reflecting changes in heart rate and ventricular repolarization behavior. It is widely accepted that structural changes reflecting myocardial substrate are better identified by means of imaging techniques, Holter monitoring on the other hand provides complementary information on myocardial vulnerability and autonomic nervous system. Therefore, combining the electrocardiographic stratification with assessment of myocardial substrate may provide the complex insight into interplay between factors contributing to death. The present article reviews the literature data on the prognostic role of various Holter-based ECG parameters, with special emphasis to dynamic ECG risk markers--heart rate variability, heart rate turbulence, repolarization dynamics and variability--in predicting mortality, as well as different modes of death in patients with CHF.
充血性心力衰竭（CHF）是一种日益普遍、代价高昂且致命的疾病，常被称为21世纪的流行病。尽管现代治疗取得了进展，但CHF患者的死亡率仍然很高。因此，CHF患者的风险分层仍然是当代心脏病学的主要挑战之一。基于动态心电图监测的心电图参数已被证明是全因死亡率和心力衰竭进展的独立风险预测指标。近年来，人们对评估反映心率和心室复极行为变化的动态心电图衍生标记物的兴趣日益增加。人们普遍认为，通过成像技术能更好地识别反映心肌基质的结构变化，而动态心电图监测则提供了有关心肌易损性和自主神经系统的补充信息。因此，将心电图分层与心肌基质评估相结合，可能会深入了解导致死亡的各种因素之间的相互作用。本文综述了关于各种基于动态心电图的心电图参数预后作用的文献数据，特别强调了动态心电图风险标记物——心率变异性、心率震荡、复极动力学和变异性——在预测CHF患者死亡率以及不同死亡模式方面的作用。
