Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, P,R, China.
BMC Cardiovasc Disord. 2014 Apr 13;14:50. doi: 10.1186/1471-2261-14-50.
This study is aimed to evaluate the clinical significance of heart rate turbulence (HRT) parameters in predicting the prognosis in patients with chronic heart failure (CHF).
From June 2011 to December 2012, a total of 104 CHF patients and 30 healthy controls were enrolled in this study. We obtained a 24-hour Holter ECG recording to assess the HRT parameters, included turbulence onset (TO), turbulence slope (TS), standard deviation of N-N intervals (SDNN), and resting heart rate (RHR). The relationships between HRT parameters and the prognosis of CHF patients were determined.
The assessment follow-up period lasted until January 31, 2013. The overall mortality of CHF patients was 9.6% (10/104). Our results revealed that CHF patients had higher levels of TO than those of healthy subjects, but the TS levels of CHF patients were lower than that of the control group. CHF patients with NYHA grade IV had higher HRT1/2 rate than those with NYHA grade II/III. There were statistical differences in TS, LVEF, SDNN and RHR between the non-deteriorating group and the non-survivor group. Significant differences in TS among the three groups were also found. Furthermore, CHF patients in the non-survivor group had lower levels of TS than those in the deteriorating group. Correlation analyses indicated that TO negatively correlate with SDNN, while TS positively correlated with SDNN and left ventricular ejection fraction (LVEF). We also observed negative correlations between TS and left ventricular end-diastolic cavity dimension (LVEDD), RHR, homocysteine (Hcy) and C-reactive protein (CRP). Multivariate Cox regression analysis further confirmed that LVEF (≤30%), HRT2, SDNN and RHR were independent risk factors which can indicate poor prognosis in CHF patients.
Our findings indicate that HRT may have good clinical predictive value in patients with CHF. Thus, quantifying HRT parameters could be a useful tool for predicting mortality in CHF patients.
本研究旨在评估心率震荡（HRT）参数在预测慢性心力衰竭（CHF）患者预后中的临床意义。
本研究共纳入 104 例 CHF 患者和 30 例健康对照者，于 2011 年 6 月至 2012 年 12 月期间进行 24 小时动态心电图记录，以评估 HRT 参数，包括震荡初始（TO）、震荡斜率（TS）、NN 间期标准差（SDNN）和静息心率（RHR）。确定 HRT 参数与 CHF 患者预后的关系。
评估随访期截至 2013 年 1 月 31 日。CHF 患者的总死亡率为 9.6%（10/104）。结果显示，CHF 患者的 TO 水平高于健康对照组，但 TS 水平低于对照组。NYHA 分级 IV 的 CHF 患者的 HRT1/2 率高于 NYHA 分级 II/III 的患者。TS、LVEF、SDNN 和 RHR 在非恶化组和非存活组之间存在统计学差异。TS 在非恶化组和非存活组之间也存在显著差异。此外，非存活组 CHF 患者的 TS 水平低于恶化组。相关性分析表明，TO 与 SDNN 呈负相关，而 TS 与 SDNN 和左心室射血分数（LVEF）呈正相关。我们还观察到 TS 与左心室舒张末期腔径（LVEDD）、RHR、同型半胱氨酸（Hcy）和 C 反应蛋白（CRP）呈负相关。多变量 Cox 回归分析进一步证实，LVEF（≤30%）、HRT2、SDNN 和 RHR 是 CHF 患者预后不良的独立危险因素。
本研究结果表明，HRT 对 CHF 患者可能具有良好的临床预测价值。因此，量化 HRT 参数可能是预测 CHF 患者死亡率的有用工具。
