Sredniawa Beata, Cebula Sylwia, Kowalczyk Jacek, Batchvarov Velislav N, Musialik-Lydka Agata, Sliwinska Anna, Wozniak Aleksandra, Zakliczynski Michal, Zembala Marian, Kalarus Zbigniew
Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland.
Ann Noninvasive Electrocardiol. 2010 Jul;15(3):230-7. doi: 10.1111/j.1542-474X.2010.00369.x.
Previous studies have shown conflicting results about the value of heart rate turbulence (HRT) for risk stratification of patients (pts) with chronic heart failure (CHF). We prospectively evaluated the relation between HRT and progression toward end-stage heart failure or all-cause mortality in patients with CHF.
HRT was assessed from 24-hour Holter recordings in 110 pts with CHF (54 in NYHA class II, 56 in class III-IV; left ventricular ejection fraction (LVEF) 30%+/- 10%) on optimal pharmacotherapy and quantified as turbulence onset (TO,%), turbulence slope (TS, ms/RR interval), and turbulence timing (beginning of RR sequence for calculation of TS, TT). TO > or = 0%, TS < or = 2.5 ms/RR, and TT >10 were considered abnormal. End point was development of end-stage CHF requiring heart transplantation (OHT) or all-cause mortality.
During a follow-up of 5.8 +/- 1.3 years, 24 pts died and 10 required OHT. TO, TS, TT, and both (TO and TS) were abnormal in 35%, 50%, 30%, and 25% of all patients, respectively. Patients with at least one relatively preserved HRT parameter (TO, TS, or TT) (n = 98) had 5-year event-free rate of 83% compared to 33% of those in whom all three parameters were abnormal (n = 12). In multivariate Cox regression analysis, the most powerful predictor of end point events was heart rate variability (SDNN < 70 ms, hazard ratio (HR) 9.41, P < 0.001), followed by LVEF < or = 35% (HR 6.23), TT > or = 10 (HR 3.14), and TO > or = 0 (HR 2.54, P < 0.05).
In patients with CHF on optimal pharmacotherapy, HRT can help to predict those at risk for progression toward OHT or death of all causes.
既往研究关于心率震荡（HRT）对慢性心力衰竭（CHF）患者危险分层的价值存在相互矛盾的结果。我们前瞻性评估了CHF患者中HRT与进展至终末期心力衰竭或全因死亡之间的关系。
对110例接受最佳药物治疗的CHF患者（纽约心脏协会（NYHA）心功能II级54例，III-IV级56例；左心室射血分数（LVEF）30%±10%）进行24小时动态心电图记录以评估HRT，并将其量化为震荡起始（TO，%）、震荡斜率（TS，ms/RR间期）和震荡发生时间（计算TS的RR序列起始点，TT）。TO≥0%、TS≤2.5 ms/RR以及TT>10被视为异常。终点为进展至需要心脏移植（OHT）的终末期CHF或全因死亡。
在5.8±1.3年的随访期间，24例患者死亡，10例需要OHT。所有患者中，TO、TS、TT以及两者（TO和TS）异常的比例分别为35%、50%、30%和25%。至少有一项HRT参数（TO、TS或TT）相对保留的患者（n = 98）5年无事件发生率为83%，而三项参数均异常的患者（n = 12）为33%。在多因素Cox回归分析中，终点事件的最强预测因素是心率变异性（SDNN<70 ms，风险比（HR）9.41，P<0.001），其次是LVEF≤35%（HR 6.23）、TT≥10（HR 3.14）以及TO≥0（HR 2.54，P<0.05）。
在接受最佳药物治疗的CHF患者中，HRT有助于预测有进展至OHT或各种原因死亡风险的患者。
