The Predictive Value Of Heart Rate Turbulence And Heart Rate Variability To Patients With The Essential Hypertension Complicated By Ventricular Premature Beats Or Non-sustained Ventricular Tachycardia

Objective:To explore the changes of heart rate turbulence(HRT) and heart rate variability (HRV) in essential hypertension(EH) patients complicated by ventricular premature beats(VPB) or non-sustained ventricular tachycardia(VT) and assess their predictive value.Methods:Three hundred and eighty-four patients with EH were enrolled,they were at least of one VPB which could analyze HRT in 24 hours Holter recorder.138 patients of occasional VPB were collected as the occasional group;125 patients of frequent VPB were collected as the frequent group;121 patients of non-sustained ventricular tachycardia(VT) were divided into the VT group and the VT storm group,70 patients who had one time VT in 24 hours were collected as the VT group,51 patients who had at least two times VT were selected by the VT storm group; 73 healthy persons were collected as normal controls.All selected persons were monitored with 24 hours Holter,the Holter instrument has the function software of two indexes of HRT which were turbulence onset(TO) and turbulence slope(TS),and indexes of HRV which were SDNN and TI,to analysis and calculate.Following-up the patients,recorded bad incidents for example heart failure,myocardial infarction and cardiac death,the endpoint incident was cardiac death, according to the result of endpoint incident,we divided the patients into two groups:the survivors group and the non-survivors group.Then analyze indexes of HRT and HRV,and assess their predictive value with Kaplan-Meier survival analysis and Cox regression analysis for high-risk patients with EH.Results:①HRT of EH patients dies down and indexes of HRV decrease,it indicated that TO in EH patients was higher and TS,SDNN and TI were lower than in normal controls,the positive rates of TO,TS,SDNN,TI were higher than in normal controls;HRT 0 grade was obviously lower and HRT 1,2 grade were obviously higher than in normal controls,they all have statistics meanings.②The effect of outer on autonomic nervous system functions was more evidence than the effect of inner on EH patients complicated by frequent VPB,VT or VT storm, they had highly bad incidents rates and death rates.③HRT and HRV of survivors group were obviously decrease.④HRT had well correlation with HRV,there was a negative correlation between TO and TI,TS presented positive correlation with SDNN and TI.TS,SDNN and TI presented negative correlation with mean heart rate,and also presented negative correlation with age.TI and VT times presented negative correlation.⑤Kaplan-Meier survival analysis show that:the cumulative survival rate of "TO＜0" in short and long term were higher than "TO≥0"(Breslow 14.89,P＜0.001;Log Rank 22.61,P＜0.001);both in short and long term,the cumulative survival rate of"TS＞2.5ms/RR" were higher than "TS≤2.5ms/RR"(Breslow 10.25, P＜0.001;Log Rank 12.54,P＜0.001);the cumulative survival rate of "both TO and TS abnormal" was lowest in short and long term(Breslow 27.76,P＜0.001;Log Rank 34.45,P＜0.001);the cumulative survival rate of "TI＞25" in short and long term was higher than "TI≤25" (Breslow 8.726,P＜0.005;Log Rank 8.738,P＜0.005).⑥In the univariate Cox regression analysis,both TO and TS abnormal was the strongest univariate mortality predictor, "TS≤2.5ms/RR" was the second strongest univariate mortality predictor,"TO≥0" was the third,"mHR＞80次/分" was the fourth and "TI≤25" was the fifth predictor.In the multivariate Cox regression analysis,both TO and TS abnormal was the only independent predictor of mortality.⑦Specificity,positive predictive value,and negative predictive value of both TO and TS abnormal were higher than TO,TS,SDNN and TI.The sensitive,specificity,positive predictive value,and negative predictive value of TS were higher than TO.Conclusion:①HRT of EH patients dies down and indexes of HRV decrease,which suggests autonomic nervous system of EH patients was out of balance;②The effect of outer on autonomic nervous system functions was more evidence than the effect of inner on EH patients complicated by frequent VPB,VT or VT storm,they had highly bad incidents rates and death rates;③HRT and HRV of survivors group were obviously decrease;④HRT had well correlation with HRV;⑤Both TO and TS abnormal was the only independent predictor of mortality.