心力衰竭合并心房颤动患者心率变异性与右心功能障碍的相关性

Correlation between heart rate variability and right ventricular dysfunction in patients with heart failure and atrial fibrillation

摘要:

目的]探讨射血分数保留的心力衰竭(HFpEF)合并心房颤动(AF)患者心率变异性(HRV)与右心功能障碍(RVD)的关系。 [方法]选取本院自2022年1月1日至2024年12月31日期间收治的128例HFpEF合并AF患者作为研究对象,根据右心功能评估结果将患者分为右心功能障碍组(n＝53)和右心功能正常组(n＝75)。采用Spearman相关评估HRV参数与右心功能参数的相关性。以HRV参数为自变量,以是否发生RVD为因变量,构建多因素广义线性混合效应模型。采用限制性立方样条探究HRV参数与RVD发生率之间的剂量-反应关系。通过ROC曲线评估HRV参数及其联合检测在RVD诊断中的价值。 [结果]右心功能障碍组HRV参数(SDNN、SDANN、RMSSD、PNN50、LF和HF)和右心功能参数(TAPSE、FAC和S′)水平低于右心功能正常组(P＜0.05)。线性分析结果显示,HRV参数与右心功能参数之间存在显著正相关(P＜0.05)。多因素广义线性混合效应模型分析结果显示,SDNN、SDANN、RMSSD、PNN50、LF及HF均与RVD的发生率呈负相关关系(β分别为－0.465、－0.205、－0.559、－0.293、－0.732、－0.147,P＜0.05)。限制性立方样条模型分析结果显示,HRV参数与RVD的发生率呈现出显著的非线性关系(P＜0.05)。HRV参数联合检测的AUC值为0.946,敏感度和特异度分别为93.56%、94.57%。 [结论]HFpEF合并AF患者的HRV与RVD的发生率之间存在负相关关系,这一发现为临床评估和治疗提供了重要的理论依据。

Abstract:

Aim To study the correlation between heart rate variability (HRV) and right ventricular dysfunction (RVD) in patients with heart failure with preserved ejection fraction (HFpEF) combined with atrial fibrillation (AF). Methods 128 patients with HFpEF and AF admitted to our hospital from January 1,2 to December 1,4 were selected as the research subjects. Based on the results of right heart function assessment, the patients were divided into two groups:the right ventricular dysfunction group (n＝53) and the normal right ventricular function group (n＝75). Spearman correlation was employed to assess the correlation between HRV parameters and right ventricular function parameters. A multi-factor generalized linear mixed-effects model was constructed, with HRV parameters as independent variables and RVD as the dependent variable. Restricted cubic splines were used to investigate the dose-response relationship between HRV parameters and the incidence of RVD. Additionally, the diagnostic value of HRV parameters and combined detection for RVD was analyzed using the ROC curve. Results The levels of HRV parameters (SDNN, SDANN, RMSSD, PNN50, LF and HF) and right ventricular function parameters (TAPSE, FAC and S′) in the right ventricular dysfunction group were significantly lower than those in the normal right ventricular function group (P＜0.05). Linear analysis revealed a significant positive correlation between HRV parameters and right ventricular function parameters (P＜0.05). Multifactor generalized linear mixed-effects model analysis demonstrated that SDNN, SDANN, RMSSD, PNN50, LF and HF were negatively correlated with the incidence of RVD (the β coefficients were －0.465, －0.205, －0.559, －0.293, －0.732, and －0.147, respectively, P＜0.05). Restricted cubic spline model analysis indicated a significant nonlinear relationship between HRV parameters and the incidence of RVD (P＜0.05). The AUC value of combined detection of HRV parameters was 0.946, with sensitivity and specificity of 93.56% and 94.57%, respectively. Conclusion There is a negative correlation between HRV and the incidence of RVD in patients with HFpEF combined with AF.This result offers a critical theoretical foundation for clinical assessment and therapeutic strategies.