短期心率变化强烈预测慢性心力衰竭患者突然心脏死亡
Maria Teresa La Rovere1, Gian Domenico Pinna, Roberto Maestri
1Divisione di Cardiologia e Bioingegneria, Fondazione Salvatore Maugeri, IRCCS Istituto Scientifico di Montescano, Pavia, Italy. mtlarovere@fsm.it
Circulation
|February 5, 2003
概括
在受控呼吸期间减少短期心率变化 (HRV) 低频功率是慢性心力衰竭 (CHF) 患者突然心脏死亡的强有力的预测因素. 这一发现有助于识别可能受益于除器植入的人.
科学领域:
- 心脏病学 心脏病学
- 医疗技术 医疗技术 医学技术
- 生物医学工程 生物医学工程
背景情况:
- 心率变化 (HRV) 在慢性心力衰竭 (CHF) 中具有潜在的预测价值.
- 之前的研究缺乏全面的多变量模型,使用短期记录来减轻混因素.
- 呼吸和行为对HRV的影响需要在预测模型中仔细考虑.
研究的目的:
- 开发和验证一种多变量生存模型,用于预测CHF患者的突然死亡.
- 评估短期HRV参数的预测值,特别是控制呼吸期间的低频功率 (LFP).
- 识别其他临床和功能参数独立的CHF突然死亡的独立预测因子.
主要方法:
- 开发了一个多变量生存模型,使用202名CHF患者的心电图记录 (衍生样本).
- 在受控呼吸期间 (8分钟心电图) 分析了时间和频率域HRV参数 (12-15次呼吸/分钟).
- 在242名CHF患者的单独队列中验证了该模型 (验证样本).
主要成果:
- 在衍生样本中,控制呼吸期间的低LFP (<或 =13 ms2) 和增加的左心室终端透气直径 (>或 =77 mm) 独立地预测了突然死亡.
- 导出模型在验证样本 (P=0.04) 中仍然是一个重要的预测因素.
- 在验证样本中,低LFP (<或=11 ms2) 和高心室过早收缩 (>或=83/小时) 独立预测突然死亡.
结论:
- 在受控呼吸期间减少短期LFP是慢性心脏病患者突然死亡的强大,独立的预测因素.
- 这些发现提高了识别高风险突发心脏事件的CHF患者的能力.
- 这些结果支持使用HRV评估来指导预防性心脏除器植入的决策.
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