Abstract: Background　The number of patients with heart failure has increased because of an ever growing aging population in China，with a severe long-term prognosis.Strengthening the prognosis monitoring of patients with heart failure is of great significance in delaying disease progression and reducing mortality.Objective　To investigate the predictive value of deceleration capacity（DC） of heart rate in the prognosis of patients with heart failure，and to analyze the influencing factors of moderate-high risk patients in DC risk assessment system.Methods　A total of 122 patients with heart failure diagnosed in the Department of Cardiac Function of Henan Provincial People's Hospital were recruited as subjects from January 2015 to April 2016.Patients received 24-h long-term Holter ECG recording，echocardiography，and New York Heart Association（NYHN） grading assessment 1 week before discharge，and blood samples were taken to determine amino-terminal pro-brain natriuretic peptide（NT-proBNP），red blood cell count（RBC） and hemoglobin（Hb）．Subjects underwent a one-year follow-up and were divided into poor prognosis group and good prognosis group according to the outcome of the patient's prognosis.The ROC curves of DC risk assessment system and NYHN grades were analyzed to predict prognostic adverse events（heart failure and cardiogenic death）．The DC risk assessment system was established and the patients were divided into low risk group（n=53），moderate risk group（n=39） and high risk group（n=30） according to it.Meanwhile，patients were divided into low risk group（n=38），moderate risk group（n=44） and high risk group（n=40） according to NYHN classification.Cox proportional hazards regression model was used to analyze the influencing factors of moderate-high risk patients in DC.Results　Among 122 patients with heart failure，62 patients were in the good prognosis group and 60 patients were in the poor prognosis group.The poor prognosis rate of heart failure was 49.2%.The area under the curve（AUC） of adverse cardiac events and cardiac death predicted by the DC value and NYHN grading was 0.806 vs 0.690，0.936 vs 0.611．As DC value could predict the critical point of heart failure and cardiogenic death in patients with heart failure，a DC risk assessment system was built.According to DC risk assessment system and NYHN grading assessment，the incidence of adverse events of heart failure in moderate risk group and high risk group was higher than that in low risk group（P<0.05）．The incidence of cardiogenic death in DC risk assessment system low and moderate risk groups was lower than that in DC risk assessment system high risk group（P<0.05）．According to NYHN grading，there was no significant difference in the incidence of cardiogenic death among patients with different risk levels （P>0.05）．Diabetes mellitus，NYHN grades，left ventricular ejection fraction（LVEF）<45%，and anemia were factors influencing prognosis of moderate-high risk of DC risk assessment system in patients with heart failure（P<0.05）．Conclusion　DC value is better than NYHN grading assessment in predicting adverse events of heart failure and cardiac death in patients with heart failure.Diabetes，NYHN grade，LVEF<45%，and anemia are influencing factors of moderate-high risk prognosis of DC in patients with heart failure.

Key words: Heart failure, Deceleration capacity of heart rate, Echocardiography, Electrocardiography, NYHN grade, Prognosis

摘要： 背景　我国人口结构老龄化严重，直接导致心力衰竭患者日益增多，远期预后形势严峻，加强心力衰竭患者预后监测对延缓病情发展、降低病死率具有重要意义。目的　探讨心率减速力（DC）对心力衰竭患者预后的预测价值，分析心力衰竭患者发生DC危险评价体系中、高危预后的影响因素。方法　选取2015年1月—2016年4月就诊于河南省人民医院心功能科确诊为心力衰竭的患者122例为研究对象。患者均于离院前1周行24 h长程动态心电图记录、超声心动图检查和纽约心脏病学会（NYHN）分级测评，并采集血样测定氨基末端脑钠肽前体（NT-proBNP）、红细胞计数（RBC）、血红蛋白（Hb）。对患者进行为期1年的随访，根据患者预后分为预后良好组和预后不良组。分别绘制DC和NYHN分级预测预后不良事件（心力衰竭不良事件和心源性死亡）的ROC曲线，建立DC危险评价体系，分为DC危险评价体系低危组（53例）、DC危险评价体系中危组（39例）、DC危险评价体系高危组（30例）。同时依据NYHN分级将患者分为NYHN低危组（38例）、NYHN中危组（44例）、NYHN高危组（40例）。采用Cox比例风险回归模型分析发生DC危险评价体系中、高危预后的影响因素。结果　122例心力衰竭患者中预后良好62例，预后不良60例。心力衰竭预后不良率为49.2%。DC、NYHN分级预测心力衰竭不良事件及心源性死亡的ROC曲线下面积（AUC）分别为0.806与0.690、0.936与0.611。依据DC预测心力衰竭患者发生心力衰竭不良事件及心源性死亡的临界值构建DC危险评价体系。DC危险评价体系、NYHN中、高危组患者心力衰竭不良事件发生率均高于DC危险评价体系、NYHN低危组（P<0.05）。DC危险评价体系低、中危组患者心源性死亡发生率低于DC危险评价体系高危组（P<0.05）。不同NYHN危险程度患者心源性死亡发生率比较，差异无统计学意义（P>0.05）。糖尿病病史、NYHN分级、左心室射血分数（LVEF）<45%、贫血是心力衰竭患者发生DC危险评价体系中、高危预后的影响因素（P<0.05）。结论　DC危险评价体系对心力衰竭患者心力衰竭不良事件及心源性死亡的预测效能优于NYHN分级。糖尿病病史、NYHN分级、LVEF<45%、贫血是心力衰竭患者发生DC危险评价体系中、高危预后的影响因素。

关键词: 心力衰竭, 心率减速力, 超声心动描记术, 心电描记术, NYHN分级, 预后