The Change And Prognostic Value Of HRT In CHF Patients

Objective To invest the change and prognostic value of heart rate turbulence(HRT)in chronic heart failure(CHF) patients.Methods 102 CHF patients and 60 health person were enrolled. CHF patients were classified into mild group(NYHAⅠ-Ⅱ)and severe group(NYHAⅢ-Ⅳ)according to NYHA classification; ischemic heart disease group and nonischemic heart disease group according to etiopathogenisis.Left ventricular ejection fraction(LVEF)were measured by Ultrasonic Cardiography. Heart rate variability(HRV), mean heart rate,Turbulence onset(TO)and turbulence slope(TS)were calculated from Holter records. Patients were classified into the following HRT categories: HRT0 if both TO and TS were normal;HRT1 if either TO or TS was abnormal;or HRT2 if both TO and TS were abnormal. Then patients were followed up. The primary end point was cardiac mortality. According to the results, patients were divided into the survival group and the death group. We determined high risk factors according to previous danger stratification. The predictive value for high-risk patients with CHF were assessed by the variables between the two groups.Results The TO of the CHF patients were significantly higher than those of the control group(P<0.05),The TS were significantly lower than those of the control group(P<0.01);The TS of the severe group were lower than those of the mild group(P<0.05);There was no significant difference of TO and TS between ischemic heart disease group and nonischemic heart disease group(P>0.05). During a follow-up of 6-39 (19.50±10.39 ) months,13 patients died,89 survived. The TS of the death group were significantly lower than those of the survival group(P<0.05);There was no significant correlation between TO and other variables(P>0.05); There was significant correlation between TS and mean heart rate(P<0.05); Univariately, age≥65 years, LVEF≤35%, SDNN<70ms, mean heart rate≥75bpm, ventricular tachyrhythmia, HRT1 ,HRT2 could predict the end point,HRT2 was the strongest predictor(hazard ratio 8.13,P<0.001); Multivariately,only LVEF≤35%(RR=3.68),ventricular tachyrhythmia(RR=3.14), and HRT(2RR=4.92)had prognostic value to the primary end point; survival functions suggested that there had significant survival status difference among HRT0 group,HRT1 group,HRT2 group(P<0.001), HRT2 group had the worst prognosis.