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目的分析扩张型心肌病(DCM)患者心率震荡(HRT)的特点。方法从2000年10月～2007年11月就诊的DCM患者中选取符合HRT分析条件的31例患者(DCM组),同时选取同期30例健康者作为对照组,比较两组的震荡初始(TO)和震荡斜率(TS),并分析TO、TS与心率变异性指标、左室射血分数(LVEF)及左室舒张末期内径(LVEDD)等之间的相关性。结果DCM组中,TO>0且TS<2.5者8例(25.8%),TO>0且TS>2.5者8例(25.8%),TO<0且TS<2.5者7例(22.6%),TO<0且TS>2.5者8例(25.8%)。两组TO值分别为-0.06±0.03、0.04±0.02,TS值分别为37.2±17.6ms/RRI、11.8±9.7ms/RRI,两组间比较TO、TS值均有统计学差异(p<0.01)。两组正常窦性RR间期的标准差(SDNN)、SDANN、LVEF、LVEDD等指标均有统计学差异(p<0.01)。DCM组TO值与LVEF、SDNN、SDANN之间呈明显负相关,与LVEDD呈明显正相关;TS值与LVEF、SDNN、SDANN之间呈明显正相关,与LVEDD呈明显负相关。结论DCM患者室性早搏后的HRT现象减弱或消失,HRT指标与SDNN、SDANN、LVEF、LVEDD等指标有较好的相关性,可作为DCM患者预后指标之一。
Objective To analyze the characteristics of heart rate turbulence (HRT) in patients with dilated cardiomyopathy (DCM). Methods Thirty-one patients (DCM group) who were eligible for HRT analysis were selected from DCM patients treated from October 2000 to November 2007. 30 healthy subjects were selected as the control group. The initial TO, (TS). The correlation between TO, TS and heart rate variability, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD) and so on were also analyzed. Results In DCM group, eight patients (25.8%) with TO> 0 and TS <2.5, eight patients (25.8%) with TO> 0 and TS> 2.5 and seven patients (22.6%) with TO < 8 cases (25.8%) were TO <0 and TS> 2.5. The TO values of the two groups were -0.06 ± 0.03 and 0.04 ± 0.02 respectively, the TS values were 37.2 ± 17.6ms / RRI and 11.8 ± 9.7ms / RRI, respectively. The TO and TS values of the two groups were statistically different (p <0.01 ). There were significant differences in SDNN, SDANN, LVEF and LVEDD between the two groups (p <0.01). The TO value in DCM group was negatively correlated with LVEF, SDNN and SDANN, and positively correlated with LVEDD. TS value was positively correlated with LVEF, SDNN and SDANN, but negatively correlated with LVEDD. Conclusions The HRT phenomenon in patients with DCM after premature ventricular contraction is weakened or disappeared. There is a good correlation between HRT index and indexes of SDNN, SDANN, LVEF and LVEDD, which can be used as one of the prognostic indicators in patients with DCM.