蔡青峰林中生TSAI, CHIN-FENGLIN, CHUNG-SHENG施榮彰SHIH, JUNG-CHANGJUNG-CHANGSHIH醫學研究所碩士班2026-10-292026-02-2220262026-01-22https://handle.ncl.edu.tw/11296/u498hmhttps://scholars.csmu.edu.tw/handle/123456789/36764研究目的心臟衰竭（heart failure, HF）為高死亡率與高再住院率之臨床症候群。過去大型臨床試驗顯示心跳速率（heart rate, HR）與慢性心臟衰竭預後相關；然而 HR 與更敏感之心肌力學指標——左心室整體縱向應變（global longitudinal strain, GLS）之關聯，及其在不同心律型態下是否一致，仍待釐清。本研究旨在探討急性心衰竭住院病人之 HR 與 GLS、NT-proBNP 之關聯，並依基礎心律型態進行分層分析。研究方法本研究為單中心前瞻性觀察研究，收錄 2023 年 10 月至 2025 年 2 月因急性心衰竭住院之成年患者（NT-proBNP ≥ 1,000 pg/mL）。於急診基線、出院後 3 個月及 6 個月收集 12 導程心電圖心跳速率、心臟超音波 GLS 與 NT-proBNP（對數轉換）。以線性迴歸檢視 HR（及變化量 ΔHR）與 GLS（及 ΔGLS）及 Δlog₁₀ NT-proBNP 之關聯，並依基線心律分為竇性心律（Sinus rhythm, SR）與心房顫動（atrial fibrillation, AF）進行次群分析。研究結果 共納入 30 例（72.4 ± 13.2 歲；女性 63%；AF 53%）。追蹤期間整體呈心跳速率(HR)下降、GLS 絕對值增加與 NT-proBNP 下降之趨勢。分層分析顯示關聯具有心律特異性：SR 組中，急診 HR 與住院 GLS 呈顯著正相關（p = 0.017），ΔHR 與 ΔGLS 呈接近統計顯著之正向關聯（p = 0.052）；SR 組 HR 與 NT-proBNP 之關聯不顯著。AF 組中，HR 與 GLS/ΔGLS 未見穩定線性關聯；相對地，ΔHR 與 Δlog₁₀ NT-proBNP 呈顯著正相關（p = 0.032）。結論急性心衰竭住院病人中，HR 與 GLS、NT-proBNP 之關聯呈現心律特異性：在 SR組，HR 與 GLS 之關聯較明顯；在 AF組，HR 的變化與 NT-proBNP 下降較一致。臨床解讀 HR 時宜考量心律型態，並整合 GLS 與 NT-proBNP 進行追蹤評估。本研究為單中心小樣本觀察研究，結果屬假說生成，仍需更大規模研究驗證。ObjectiveHeart failure (HF) is associated with high mortality and rehospitalization. Although heart rate (HR) is a recognized prognostic marker in chronic HF, the association between HR and myocardial mechanics—particularly global longitudinal strain (GLS)—remains less well characterized, and whether such associations differ by underlying rhythm is unclear. This study investigated the associations of HR with GLS and NT-proBNP in patients hospitalized for acute HF, with rhythm-stratified analyses in sinus rhythm (SR) and atrial fibrillation (AF).MethodsThis single-center prospective observational study enrolled adult patients hospitalized for acute HF (NYHA class II–IV) with NT-proBNP ≥ 1,000 pg/mL at Asia University Hospital (October 2023 to February 2025). HR was obtained from 12-lead ECG at the emergency department (baseline) and at 3 and 6 months after discharge. GLS was measured by 2D speckle-tracking echocardiography during hospitalization and at follow-up visits. NT-proBNP was log-transformed for analyses. Linear regression was used to examine associations between HR (and ΔHR) and GLS (and ΔGLS) as well as Δlog₁₀ NT-proBNP. Subgroup analyses were performed by baseline rhythm (SR vs AF).ResultsThirty patients were analyzed (mean age 72.4 ± 13.2 years; 63% female; AF 53%; SR n=14, AF n=16). Over 6 months, the cohort showed descriptive trends toward lower HR, greater absolute GLS, and lower NT-proBNP. Rhythm-stratified analyses suggested rhythm-specific patterns: in SR, baseline HR was positively associated with in-hospital GLS (p=0.017), and ΔHR was borderline associated with ΔGLS (p=0.052), while HR was not significantly associated with NT-proBNP. In AF, HR was not consistently associated with GLS or ΔGLS; conversely, ΔHR was positively associated with Δlog₁₀ NT-proBNP over 3 months (p=0.032).ConclusionIn patients hospitalized for acute HF, the associations between HR and GLS/NT-proBNP appeared to differ by rhythm. In SR, HR was more closely related to longitudinal systolic mechanics, whereas in AF, HR change aligned more consistently with changes in NT-proBNP. A rhythm-guided interpretation integrating HR with GLS and NT-proBNP may be clinically useful. Given the single-center design and small sample size, these findings are hypothesis-generating and warrant validation in larger studies.心臟衰竭斑點追蹤心臟超音波左心室整體縱向應變 (GLS)心跳速率NT-proBNPHeart failureSpeckle tracking echocardiographyGlobal longitudinal strain (GLS)Heart ratethesis