Smilde Tom D J, van Veldhuisen Dirk J, van den Berg Maarten P
Department of Cardiology, Thorax Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Clin Res Cardiol. 2009 Apr;98(4):233-9. doi: 10.1007/s00392-009-0747-0. Epub 2009 Feb 13.
In contrast to patients with moderate to severe chronic heart failure (CHF), data regarding long-term outcome in patients with mild CHF are scarce. We examined the place of Holter monitoring to study the prognostic value of ventricular arrhythmias and heart rate variability (HRV) in patients with mild to moderate CHF during long-term follow-up.
We studied 90 patients with mild to moderate CHF and NYHA class II who had been enrolled in the Dutch Ibopamine Multicenter Trial. At baseline their mean age was 60.5 +/- 8.0 years, left ventricular ejection fraction (LVEF) was 0.29 +/- 0.09, and 85% were males. At the start of the study, patients were only using diuretics, while digoxin, and particularly ACE inhibitors and beta-blockers were initiated later. Univariate and multivariate proportional hazard analyses were performed.
At baseline 80% of patients were in NYHA class II, and 20% were in class III; their mean age was 60 years, mean LVEF was 0.29, and 85% were men. During a follow-up of 13 years, 47 patients (53%) died. Cardiovascular (CV) death occurred in 39 patients, of which 28 were sudden cardiac death (SCD). For both CV death and SCD, LVEF <30% and ventricular premature beats/h (>20) were independent risk markers. Of the HRV parameters, total power (>2,500 ms(2)) was an important risk marker for CV death, but not for SCD.
The present 13-year follow-up study in 90 patients with mild to moderate CHF showed that ventricular premature beats and HRV may have important value in predicting outcome.
与中重度慢性心力衰竭（CHF）患者相比，轻度CHF患者长期预后的数据较少。我们研究了动态心电图监测在轻度至中度CHF患者长期随访期间对室性心律失常和心率变异性（HRV）预后价值的评估作用。
我们研究了90例轻度至中度CHF且纽约心脏协会（NYHA）心功能分级为II级的患者，这些患者入选了荷兰异波帕明多中心试验。基线时，他们的平均年龄为60.5±8.0岁，左心室射血分数（LVEF）为0.29±0.09，85%为男性。研究开始时，患者仅使用利尿剂，后来开始使用地高辛，尤其是血管紧张素转换酶抑制剂和β受体阻滞剂。进行了单因素和多因素比例风险分析。
基线时，80%的患者为NYHA II级，20%为III级；他们的平均年龄为岁，平均LVEF为0.29，85%为男性。在13年的随访期间，47例患者（53%）死亡。39例患者发生心血管（CV）死亡，其中28例为心源性猝死（SCD）。对于CV死亡和SCD，LVEF<30%和室性早搏/小时（>20）是独立的风险标志物。在HRV参数中，总功率（>2500ms²）是CV死亡的重要风险标志物，但不是SCD的风险标志物。
这项对90例轻度至中度CHF患者进行的13年随访研究表明，室性早搏和HRV在预测预后方面可能具有重要价值。
