目的 探究冠心病(Coronary heart disease,CHD)患者焦虑水平与动态心电图心率变异性的关联及其预后意义.方法 选取2021年1月～2023年1月本院收治的80例CHD患者实施回顾性研究,分析CHD患者冠脉狭窄状况与焦虑评分相关性,比较不同焦虑程度患者动态心电图心率变异性指标的差异,并分析焦虑程度与动态心电图心率变异性相关性;对患者进行随访(截止2023年11月),观察不同焦虑程度CHD患者预后状况,分析焦虑状态、相邻正常心动周期差值的均方根(root Mean Square Successive Differences,rMSSD)、相邻两个正常心动周期差值大于50 ms的个数所占的百分比(the Proportion of NN50,PNN50)、24 h内全部正常心动周期的标准差(the Standard Deviation of NN intervals,SDNN)预测预后的价值效能.结果 焦虑评分与冠脉狭窄状况无明显相关(P＞0.05).不同焦虑程度患者动态心电图心率变异性指标(rMSSD、PNN50、SDNN)比较差异存在统计学意义(P＜0.05),重度焦虑组rMSSD、PNN50、SDNN＞轻度焦虑组＞无焦虑组(P＜0.05).Pearson 相关系数显示,焦虑状态与 rMSSD、PNN50、SDNN 呈负相关(r=-0.561、-0.652、-0.559,P＜0.05).焦虑组预后不良总发生率高于无焦虑组(P＜0.05).二元Logistic回归分析显示,存在焦虑、rMSSD、PNN50、SDNN均是预后的影响因素(P＜0.05).ROC曲线分析显示,焦虑状态、rMSSD、PNN50、SDNN预测预后的 AUC 分别为 0.782、0.752、0.775、0.761.结论 CHD 患者焦虑水平与动态心电图心率变异性具有密切相关,而焦虑水平、动态心电图心率变异性是预后不良影响因素,可作为临床预测CHD预后状况的有效指标.
Association and prognostic significance of anxiety level with heart rate variability in dynamic electrocardio-gram in patients with coronary heart disease
Objective To explore the association between anxiety level and heart rate variability in dynamic electrocardiogram and its prognostic significance in patients with coronary heart disease(CHD).Methods A retro-spective study was conducted on 80 patients with CHD admitted to our hospital from January 2021 to January 2023.The correlation between coronary stenosis status and anxiety scores was analyzed in CHD patients.The differences in heart rate variability indices were compared in patients with different anxiety levels,and the correlation between anxiety level and heart rate variability was analyzed.The patients were followed up(as of November 2023)to observe the prognosis of CHD patients with different anxiety levels.The prognostic value of anxiety status,root mean square successive dif-ferences(rMSSD),percent of differences between adjacent normal RR intervals that are greater than 50 ms(PNN50),and standard deviation of all normal RR intervals within 24 hours(SDNN)for predicting prognosis were analyzed.Results There was no significant correlation between anxiety score and coronary stenosis status(P＞0.05).There were significant differences in heart rate variability indices(rMSSD,PNN50,SDNN)among patients with different anxiety levels(P＜0.05).The rMSSD,PNN50,and SDNN in the severe anxiety group were higher than those in the mild anxiety group,which were higher than those in the non-anxiety group(P＜0.05).Person correlation coefficient showed a negative correlation between anxiety status and rMSSD,PNN50,and SDNN(r=-0.561,-0.652,-0.559,P＜0.05).The total incidence of adverse prognosis in the anxiety group was higher than that in the non-anxiety group(P＜0.05).Binary logistic regression analysis showed that anxiety,rMSSD,PNN50,and SDNN were all factors affecting prognosis(P＜0.05).ROC curve analysis showed that the AUCs of anxiety status,rMSSD,PNN50,and SDNN for predicting prognosis were 0.782,0.752,0.775,and 0.761,respectively.Conclusion There is a close relationship between anxiety level and heart rate variability in dynamic electrocardiogram in CHD patients.Anxiety level and heart rate variability are factors that affect prognosis and can be used as effective indicators for clinical prediction of CHD prognosis.
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