Association of holter monitoring (24-hour ECG) parameters with improvement in left ventricular ejection fraction in heart failure with reduced ejection fraction
-
摘要:
目的 通过分析射血分数减低型心力衰竭(HFrEF)患者临床资料, 探讨心率变异性(HRV)及心律失常对HFrEF患者左室射血分数(LVEF)改善的预测价值。 方法 在2018年11月-2021年11月首次因心力衰竭于安徽医科大学附属省立医院住院治疗的HFrEF患者1 344例中, 筛选包含基线24小时动态心电图和1年内心脏彩超随访的患者共286例, 用于HRV分析的窦性心律患者210例。根据基线和随访心脏彩超将患者分为射血分数改善型心力衰竭(HFimpEF)组和对照组。比较2组患者基线临床资料、心脏彩超、24小时动态心电指标的差异, 采用logistic回归分析研究LVEF改善的影响因素。 结果 132例(46.2%)符合HFimpEF组定义, 其余154人作为对照组。HFimpEF组患者多为女性, 基线时拥有更高的每5分钟窦性RR间期标准差均值(SDNN Index)。多因素logistic回归分析显示, 心律失常指标不是LVEF改善的影响因素; 窦性心律患者中, 基线SDNN Index (OR=1.026, 95%CI: 1.008~1.044, P=0.004)与LVEF改善独立相关。 结论 在窦性心律HFrEF患者中, 基线心率变异性指标SDNN Index是HFrEF患者治疗后LVEF改善的独立影响因素。 Abstract:Objective To evaluate the association between heart rate variability (HRV) and arrhythmias on the improvement of left ventricular ejection fraction (LVEF) by analyzing the clinical data from patients with heart failure with reduced ejection fraction (HFrEF). Methods Among 1 344 HFrEF patients first admitted to Anhui Medical University Provincial Hospital for heart failure from November 2018 to November 2021, a total of 286 HFrEF patients with holter monitoring (24-hour ECG) at baseline and echocardiography followed-up within 1 year were screened, and 210 HFrEF patients with sinus rhythm were used for HRV analysis.Patients were divided into a heart failure with improved ejection fraction (HFimpEF) group and control group according to baseline and follow-up echocardiography.The differences between the 2 groups in baseline clinical data, echocardiographic and 24-hour holter monitoring parameters were compared, and logistic regression analysis was used to investigate the factors influencing the improvement in LVEF. Results One hundred and thirty-two patients (46.2%) met the criteria of HFimpEF group, with the remaining 154 patients served as control group.HFimpEF patients were mostly female, with higher the mean of the standard deviations of all normal sinus NN intervals for all 5-min segments (SDNN index).Multifactorial logistic regression analysis showed that arrhythmias index was not an influential factor in LVEF improvement; baseline SDNN index (OR: 1.026, 95%CI: 1.008-1.044, P=0.004) was independently associated with LVEF improvement in patients with sinus rhythm. Conclusion In HFrEF patients with sinus rhythm, the SDNN Index is an independent predictor of LVEF improvement. -
Key words:
- Heart failure /
- Left ventricular ejection fraction /
- Reduced /
- Improved /
- Heart rate variability /
- Arrhythmia
-
表 1 HFimpEF组与对照组患者临床资料比较
Table 1. Comparison of clinical data between HFimpEF group and control group
变量 HFimpEF组(132例) 对照组(154例) 统计量 P值 一般资料 年龄[M(P25, P75)，岁] 65.00(49.25, 75.00) 68.00(57.00, 75.00) -1.452a 0.147 性别[例(%)] 4.120b 0.042 女性 49(37.12) 40(25.97) 男性 83(62.88) 114(74.03) 高血压[例(%)] 56(42.42) 55(35.71) 1.348b 0.246 冠心病[例(%)] 50(37.88) 70(45.46) 1.675b 0.196 2型糖尿病[例(%)] 25(18.94) 36(23.38) 0.834b 0.361 脑卒中[例(%)] 30(22.73) 42(27.27) 0.780b 0.377 超声心动图 LVEF[M(P25, P75)，%] 32.00(28.00, 35.00) 33.00(25.00, 37.00) -0.736a 0.462 LVEDD[M(P25, P75)，mm] 65.46(64.00, 72.00) 68.00(63.00, 76.00) -2.623a 0.009 LVESD[M(P25, P75)，mm] 55.29(55.00, 61.00) 53.00(56.00, 64.00) -2.017a 0.044 LAD[M(P25, P75)，mm] 43.29(42.00, 48.00) 48.00(44.75, 52.25) -5.033a < 0.001 LVPWT[M(P25, P75)，mm] 10.00(10.00, 10.00) 9.00(8.00, 10.00) -5.019a < 0.001 IVS[M(P25, P75)，mm] 10.00(9.25, 10.00) 9.50(9.00, 10.00) -3.468a < 0.001 PASP[M(P25, P75)，mmHg] 41.79(33.00, 56.00) 45.56(33.00, 55.25) -0.740a 0.542 实验室检查 血钾[M(P25, P75)，mmol/L] 3.98(3.77, 4.21) 4.08(3.73, 4.35) -1.385a 0.166 血钠[M(P25, P75)，mmol/L] 141.00(138.00, 142.00) 139.86(137.32, 141.43) -1.853a 0.064 血镁[M(P25, P75)，mmol/L] 0.84(0.77, 0.90) 0.85(0.79, 0.91) -1.439a 0.150 血肌酐[M(P25, P75)，mmol/L] 80(63.35, 100.30) 83.20(70.00, 104.00) -2.096a 0.036 血尿素氮[M(P25, P75)，mmol/L] 7.38(5.96, 9.25) 8.14(6.50, 10.10) -2.007a 0.173 肌钙蛋白Ⅰ[M(P25, P75)，ng/mL] 0.03(0.01, 0.08) 0.04(0.02, 0.09) -1.321a 0.187 NT-proBNP[M(P25, P75)，pg/mL] 2 065.00(1 059.75, 3 930.75) 3 221.00(1 774.50, 7 222.75) -3.538a < 0.001 药物治疗 ACEI/ARB[例(%)] 25(18.94) 25(16.23) 0.361b 0.548 沙库巴曲缬沙坦[例(%)] 63(47.73) 75(48.70) 0.027b 0.869 β受体阻滞剂[例(%)] 94(71.21) 88(57.14) 6.080b 0.014 达格列净[例(%)] 17(12.88) 31(20.13) 2.676b 0.102 螺内酯[例(%)] 102(77.27) 128(83.12) 1.542b 0.214 呋塞米[例(%)] 102(77.27) 121(78.57) 0.070b 0.792 心律失常 心房颤动[例(%)] 24(18.18) 40(25.97) 2.485b 0.115 心房扑动[例(%)] 1(0.75) 3(1.94) 0.730b 0.393 起搏心律[例(%)] 3(2.27) 5(3.24) 0.248b 0.618 总心搏数[M(P25, P75)，/24 h] 106 204.50(94 917.75, 121 516.00) 105 238.00(93 974.50, 118 845.00) -0.572a 0.362 室性早搏数[M(P25, P75)，/24 h] 187.00(13.75, 781.75) 438.00(42.50, 2 609.75) -2.935a 0.003 室性早搏负荷[M(P25, P75)，%] 0.16(0.01, 0.81) 0.46(0.04, 2.57) -3.019a 0.003 非持续性室性心动过速[例(%)] 48(36.36) 72(46.75) 3.150b 0.076 注：a为Z值，b为χ2值；1 mmHg=0.133 kPa；NT-proBNP为N末端-B型利钠肽前体(N-terminal pro-brain natriuretic peptide)，ACEI为血管紧张素转换酶抑制剂(angiotensin-converting enzyme inhibitor)，ARB为血管紧张素受体阻滞剂(angiotensin-receptor blocker)，PASP为肺动脉收缩压(pulmonary artery systolic pressure)，LVPWT为左室后壁厚度(left ventricular posterior wall thickness)。 
下载: 导出CSV
表 2 HFimpEF组与对照组窦性心律患者心率变异性比较[M(P25, P75)]
Table 2. Comparison of heart rate variability in patients with sinus rhythm between HFimpEF group and control group[M(P25, P75)]
组别 例数 SDNN(ms) SDANN(ms) SDNN Index(ms) rMMSD(ms) HFimpEF组 104 78.00(58.75, 103.75) 64.00(48.25, 84.00) 33.00(27.25, 49.00) 20.00(14.00, 35.00) 对照组 106 70.50(55.00, 88.00) 59.00(46.00, 72.25) 31.50(24.75, 46.25) 21.00(13.00, 31.25) Z值 -2.251 -1.907 -2.044 -0.348 P值 0.024 0.053 0.041 0.728 组别 例数 pNN50(%) LF(ms2) HF(ms2) LF/HF HFimpEF组 104 1.65(0.49, 5.89) 117.20(65.71, 218.48) 95.19(49.35, 171.64) 1.12(0.72, 1.72) 对照组 106 2.13(0.56, 6.80) 61.84(29.84, 116.11) 92.75(34.31, 190.64) 0.67(0.41, 1.08) Z值 -0.030 -4.444 -1.218 -4.167 P值 0.976 < 0.001 0.223 < 0.001
下载: 导出CSV
表 3 总体人群发生LVEF改善的多因素logistic回归分析
Table 3. Multivariate logistic regression analysis of LVEF improvement in the general population
变量 B SE Wald χ2 P值 OR值 95% CI 使用β受体阻滞剂 0.680 0.284 5.712 0.017 1.973 1.130~3.444 LAD -0.084 0.024 11.884 0.001 0.920 0.877~0.964 LVPWT 0.278 0.095 8.644 0.003 1.320 1.097~1.589
下载: 导出CSV
表 4 窦性心律人群发生LVEF改善的多因素logistic回归分析
Table 4. Multivariable logistic regression analysis for the LVEF improvement in patients with sinus rhythm
变量 B SE Wald χ2 P值 OR值 95% CI 年龄 -0.022 0.010 5.269 0.022 0.978 0.960~0.997 LAD -0.100 0.029 11.840 0.001 0.905 0.855~0.958 LVPWT 0.229 0.106 4.642 0.031 1.257 1.021~1.549 SDNN Index 0.025 0.009 8.172 0.004 1.026 1.008~1.044
下载: 导出CSV
-
[1] FANG S C, WU Y L, TSAI P S. Heart rate variability and risk of all-cause death and cardiovascular events in patients with cardiovascular disease: a meta-analysis of cohort studies[J]. Biol Res Nurs, 2020, 22(1): 45-56. doi: 10.1177/1099800419877442 [2] BOAS R, THUNE J J, PEHRSON S, et al. Prevalence and prognostic association of ventricular arrhythmia in non-ischaemic heart failure patients: results from the DANISH trial[J]. Europace, 2021, 23(4): 587-595. doi: 10.1093/europace/euaa341 [3] CORREALE M, MALLARDI A, TRICARICO L, et al. Remodelling is inversely proportional to left ventricular dimensions in a real-life population of patients with chronic heart failure after therapy with sacubitril/valsartan[J]. Acta Cardiol, 2022, 77(5): 416-421. doi: 10.1080/00015385.2021.1950371 [4] SHAH M A, SOOFI M A, JAFARY Z, et al. Echocardiographic parameters associated with recovery in heart failure with reduced ejection fraction[J]. Echocardiography, 2020, 37(10): 1574-1582. doi: 10.1111/echo.14859 [5] NISHIMURA S, IZUMI C, HIMURA Y, et al. Very long-term follow-up data of non-ischemic idiopathic dilated cardiomyopathy after beta-blocker therapy: recurrence of left ventricular dysfunction and predictive value of 123Ⅰ-metaiodobenzylguanidine scintigraphy[J]. Heart Vessels, 2019, 34(2): 259-267. doi: 10.1007/s00380-018-1245-y [6] WILCOX J E, FANG J C, MARGULIES K B, et al. Heart failure with recovered left ventricular ejection fraction: JACC scientific expert panel[J]. J Am Coll Cardiol, 2020, 76(6): 719-734. doi: 10.1016/j.jacc.2020.05.075 [7] 中华医学会心血管病学分会心力衰竭学组, 中国医师协会心力衰竭专业委员会, 中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2018[J]. 中华心血管病杂志, 2018, 46(10): 760-789. doi: 10.3760/cma.j.issn.0253-3758.2018.10.004Heart Failure Group of Chinese Society of Cardiology of Chinese Medical Association, Chinese Heart Failure Association of Chinese Medical Doctor Association, Editorial Board of Chinese Journal of Cardiology. Chinese guidelines for the diagnosis and treatment of heart failure 2018[J]. Chinese Journal of Cardiology, 2018, 46(10): 760-789. doi: 10.3760/cma.j.issn.0253-3758.2018.10.004 [8] 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American college of cardiology/American heart association joint committee on clinical practice guidelines[J]. Circulation, 2022, 145(18): e1033. DOI: 10.1161/CIR.0000000000001073 .[9] 谢彩侠, 宣玲, 康品方, 等. 沙库巴曲缬沙坦对慢性心力衰竭患者血心室重塑相关指标及心功能的影响[J]. 中华全科医学, 2022, 20(12): 2010-2014. doi: 10.16766/j.cnki.issn.1674-4152.002757XIE C X, XUAN L, KANG P F, et al. Influence of sacubitril / valsartan on related indexes of ventricular remodeling and cardiac function in patients with chronic heart failure[J]. Chinese Journal of General Practice, 2022, 20(12): 2010-2014. doi: 10.16766/j.cnki.issn.1674-4152.002757 [10] REINHARDT S W, CHOUAIRI F, MILLER P E, et al. National trends in the burden of atrial fibrillation during hospital admissions for heart failure[J]. J Am Heart Assoc, 2021, 10(11): e019412. DOI: 10.1161/JAHA.120.019412. [11] MULDER B A, RIENSTRA M, BLAAUW Y. Evaluation and treatment of premature ventricular contractions in heart failure with reduced ejection fraction[J]. Heart, 2021, 107(1): 10-17. doi: 10.1136/heartjnl-2020-317491 [12] CARLISLE M A, FUDIM M, DEVORE A D, et al. Heart failure and atrial fibrillation, like fire and fury[J]. JACC Heart Fail, 2019, 7(6): 447-456. doi: 10.1016/j.jchf.2019.03.005 [13] 周阿培, 陈东, 胡凯, 等. 冷冻球囊消融治疗心房颤动合并心力衰竭患者临床疗效观察[J]. 中华全科医学, 2022, 20(2): 228-232. doi: 10.16766/j.cnki.issn.1674-4152.002319ZHOU A P, CHEN D, HU K, et al. Clinical effect of cryoballoon catheter ablation in patients with atrial fibrillation Combining with heart failure[J]. Chinese Journal of General Practice, 2022, 20(2): 228-232. doi: 10.16766/j.cnki.issn.1674-4152.002319 [14] TIWARI R, KUMAR R, MALIK S, et al. Analysis of heart rate variability and implication of different factors on heart rate variability[J]. Curr Cardiol Rev, 2021, 17(5): e160721189770. DOI: 10.2174/1573403X16999201231203854. [15] DZIKOWICZ D J, CAREY M G. Correlates of autonomic function, hemodynamics, and physical activity performance during exercise stress testing among firefighters[J]. Biol Res Nurs, 2022. DOI: 10.1177/10998004221143508. [16] KUBOTA Y, CHEN L Y, WHITSEL E A, et al. Heart rate variability and lifetime risk of cardiovascular disease: the Atherosclerosis Risk in Communities Study[J]. Ann Epidemiol, 2017, 27(10): 619-625. e2. doi: 10.1016/j.annepidem.2017.08.024 [17] GOULART C L, CARUSO F R, ARÊAS G P T, et al. Impact of chronic obstructive pulmonary disease on linear and nonlinear dynamics of heart rate variability in patients with heart failure[J]. Braz J Med Biol Res, 2020, 54(2): e10084. DOI: 10.1590/1414-431X202010084. [18] GUERRA L A, LTEIF C, ARWOOD M J, et al. Genetic polymorphisms in ADRB2 and ADRB1 are associated with differential survival in heart failure patients taking β-blockers[J]. Pharmacogenomics J, 2022, 22(1): 62-68. doi: 10.1038/s41397-021-00257-1 -
点击查看大图
图(1) / 表(4)
计量
- 文章访问数: 210
- HTML全文浏览量: 56
- PDF下载量: 19
- 被引次数: 0
