| Objective:To study the relationship between heart rate tubulence(HRT)and elderly patients with chronic heart failure(CHF),and to explore its clinical significance in evaluating the prognosis of elderly patients with CHF.Method:115 elderly patients with chronic heart failure(CHF)and 50 hospitalized patients without myocardial infarction and heart failure as control,NTpro-BNP levels were measured within 12 hours of admission,Left ventricular ejection fraction(LVEF)and end-diastolic left ventricular diameter(LVEDD)were measured by echocardiography,24 hours of dynamic ECG monitoring were measured during admission,to calculate two parameters of HRT: Turbulence onset(TO)and Turbulence slope(TS).The levels of TO,TS,LVEF,LVEDD and NTpro-BNP in CHF group and control group were compared,and the adverse prognosis of CHF group was followed up at 6 months after discharge.Poor prognosis such as readmission and death;Logisitic regression was used to analyze the correlation between TO,TS,LVEF,LVEDD,NTpro-BNP,HRT and death.SPSS22.0 statistical software was used for statistical analysis.The TO value,TS value,LVEF value,LVEDD value and NTpro-BNP level of the study subjects were expressed as mean ±standard deviation.The mean sample comparison between groups was performed by t test;the count data was analyzed by ?2 test;CHF patients with TO value,TS Correlation analysis of values with BNP levels,LVEF,LVEDD values,and HRT grades was performed using linear correlation analysis.Logistic regression analysis was used to analyze the values of TO,TS,LVEF,LVEDD and NTpro-BNP.Level,HRT grading and mortality were correlated.P?0.05 was considered statistically significant.Results:1.The TO value and LVEDD value in the heart failure group were significantly higher than those in the control group(P<0.001,P<0.001).The TS value and LVEF value in the heart failure group were significantly lower than those in the control group(P<0.001,P<0.001).There were no significant differences in age at the group(P>0.05).2.The values of TS and LVEF in the heart function class ? and ?patients were significantly lower than those in the heart function class II patients(P<0.05),and the levels of TO and NTpro-BNP were significantly higher than those in the heart function class II patients(P<0.05).The value of TS in the heart function class ? was significantly lower than that of patients in the heart function class ?(P<0.05).There was no significant difference in TS value between patients with grade ?cardiac function and patients with grade?cardiac function(P>0.05).There was no significant difference in TO and TSbetween the patients of class ? and ?,? and ?(P>0.05);NTpro-BNP level increased with the increase of cardiac function grade,and there were significant differences between the groups of different degrees of heart failure(P?0.01).LVEF value decreased with the increase of cardiac function grade,and LVEF was significantly different between the groups of different degrees of heart failure(P?0.05);There was significant difference in LVEDD between mild(class ?)and moderate(class ?)heart failure groups(P?0.05),but no significant difference between moderate and severe(class ?)heart failure groups(P>0.05).3.According to Pearson correlation analysis,TO and LVEF values were negatively correlated(r=-0.821,P<0.001),and TO was positively correlated with LVEDD and NTpro-BNP(r=0.448,P?0.001,r=0.288,P?0.01).TS was positively correlated with LVEF(r=0.559,P?0.001),and TS was negatively correlated with LVEDD and NTpro-BNP(r=-0.350,P?0.001,r=-0.335,P?0.001).4.The levels of TO and NTpro-BNP in the dead patients were significantly higher than those in the re-admitted patients with aggravated heart failure,and the values of TS and LVEF were significantly lower than those in the re-admitted and stable patients(P?0.01).HRT index and HRT grade of patients with poor prognosis were significantly worse than those of patients with stable condition(P?0.005).HRT grade of patients with poor prognosis was higher(P<0.001),TO value was higher(P<0.001),TS value was smaller(P<0.01)than that of patients with survival.Logistic regression analysis showed that HRT class 2 was positively correlated with mortality(OR=0.018,95%C.I.:0.001~0.326,P=0.007).Conclusion:1.Heart rate turbulencein in elderly patients with chronic heart failure is significantly reduced.2.In elderly patients with chronic heart failure,the value of TO was positively correlated the value of LVEDD and the level of NTpro-BNP,and negatively correlated with the value of LVEF.The value of TS was positively correlated with the LVEF value and negatively correlated with the LVEDD value and the NTpro-BNP level.3.There is a significant correlation between HRT parameters and poor prognosis in elderly patients with chronic heart failure,and poor prognosis in patients with large TO value and small TS value.4.There is a clear correlation between HRT classification and death in elderly patients with chronic heart failure,and there is a high risk of death in patients with HRT class 2. |
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