Universidade de Caxias do Sul (UCS) - Medicina, Caxias do Sul, RS - Brasil.
Sociedade Brasileira de Cardiologia - Programa de Pós-Graduação em Insuficiência Cardíaca, Rio de Janeiro, RJ - Brasil.
Arq Bras Cardiol. 2024 Aug;121(8):e20230771. doi: 10.36660/abc.20230771.
Heart rate (HR) has shown prognostic value in patients with heart failure with reduced ejection fraction (HFrEF) and sinus rhythm. However, the method of measurement is debated in the literature.
To compare HR on Holter with 3 resting electrocardiograms (ECG1, ECG2, and ECG3) in patients with HFrEF and sinus rhythm.
This was a cross-sectional study with 135 patients with heart failure with ejection fraction ≤ 40% and sinus rhythm. HR was assessed by ECG and Holter. Analyses included intraclass correlation coefficient (ICC), robust regression, root mean squared error, Bland-Altman, and area under the receiver operating characteristic (ROC) curve. A significance level of 0.05 and Bonferroni-Holm adjustment were adopted to minimize type I errors.
The median [interquartile range] age and ejection fraction were 65 years [16] and 30% [11], respectively. The ICC of the 3 ECGs was 0.922 (95% confidence interval: 0.892; 0.942). The robust regression coefficients for ECG1 and ECG3 were 0.20 (95% confidence interval: 0.12; 0.29) and 0.21 (95% confidence interval: 0.06; 0.36). The robust R2 was 0.711 (95% confidence interval: 0.628; 0.76). In the Bland-Altman agreement analysis, the limits of agreement were -17.0 (95% confidence interval: -19.0; -15.0) and 32.0 (95% confidence interval: 30.0; 34.0). The area under the ROC curve was 0.896 (95% confidence interval: 0.865; 0.923).
The HR on ECG showed high agreement with the HR on Holter, validating its clinical use in patients with HFrEF and sinus rhythm. However, agreement was suboptimal in one third of patients with HR below 70 bpm on ECG; thus, 24-hour Holter monitoring should be considered in this context.
心率（HR）在射血分数降低的心力衰竭（HFrEF）伴窦性节律患者中具有预后价值。然而，文献中对于测量方法仍存在争议。
比较 HFrEF 伴窦性节律患者动态心电图（Holter）与 3 次静息心电图（ECG1、ECG2 和 ECG3）的 HR。
这是一项横断面研究，纳入 135 例射血分数≤40%且伴窦性节律的心力衰竭患者。通过心电图和 Holter 评估 HR。分析包括组内相关系数（ICC）、稳健回归、均方根误差、Bland-Altman 分析和受试者工作特征（ROC）曲线下面积。采用 0.05 显著性水平和 Bonferroni-Holm 调整以最小化Ⅰ类错误。
中位（四分位间距）年龄和射血分数分别为 65 岁[16]和 30%[11]。3 次心电图的 ICC 为 0.922（95%置信区间：0.892；0.942）。ECG1 和 ECG3 的稳健回归系数分别为 0.20（95%置信区间：0.12；0.29）和 0.21（95%置信区间：0.06；0.36）。稳健 R2 为 0.711（95%置信区间：0.628；0.76）。在 Bland-Altman 一致性分析中，一致性界限为-17.0（95%置信区间：-19.0；-15.0）和 32.0（95%置信区间：30.0；34.0）。ROC 曲线下面积为 0.896（95%置信区间：0.865；0.923）。
心电图 HR 与 Holter 监测的 HR 高度一致，验证了其在 HFrEF 伴窦性节律患者中的临床应用。然而，在心电图 HR 低于 70 bpm 的患者中，一致性并不理想，因此在这种情况下应考虑 24 小时 Holter 监测。
