心衰患者QRS波时限与心功能的相关性研究

The relationship between QRS duration and cardiac function parameters with TDI in patients with congestive heart failure

目的探讨慢性心力衰竭(HF)患者QRS时限与组织多普勒显像(TDI)测定的收缩、舒张功能参数的相关关系。方法将104例心衰患者分为收缩性心衰(SHF,n=27)、舒张性心衰(DHF,n=49)、正常对照(n=28)3组。测量其心电图QRS时限,常规心脏超声测定EF、E/A、LVEDd、LVEDs。TDI测量二尖瓣环六位点Sm、Em,计算平均Sm、Em,评价心脏超声参数与QRS时限的相关关系。应用受试者工作特征曲线(ROC)评价平均Sm,预测QRS时限价值。结果3组QRS时限分别为106.1±24.1ms、92.6±10.7ms、96.7±15.9ms(p<0.01),QRS时限与EF、LVEDd、LVEDs、平均Sm的相关系数分别为-0.292(p<0.01)、0.364(p<0.001)、0.373(p<0.001)、-0.361(p<0.01);QRS时限与E/A、平均Em不相关;ROC分析显示平均Sm预测QRS时限≥120ms的曲线下面积为0.808(0.618-0.999,p<0.01),平均Sm界值为3.38m/s时预测QRS时限≥120ms的敏感度88.9%,特异度75.0%。结论HF患者中,SHF患者QRS时限大于DHF患者;QRS时限与收缩功能关系更为密切。

Objective To explore the relationship of QRS duration and left ventricular systolic and diastolic parameters meadured by TDI in patients with Chronic heart failure. Methods The study population was categorized according to the echocardiography： systolic dysfunction （SHF,n=27）, diastolic dysfunction （DHF,n=49）, normal （Contros, n=28 ）. The QRS interval, EF, E/A, LVEDd, LVEDs were measured by standard echocardiography. Sm, Em was measured with TDI, and average Sm and Em was calculated, the correction between QRS interval and echecardiography parameters was calculated, the correction between ejection fraction and average Sm was calculated. QRS interval was predicted by receiver operating characteristic curve （ROC）. Results The average QRS interval in three groups was 106.1 ± 24.1ms, 92.6 ± 10.7ms and 96.7 ± 15.9ms （P〈0.01）, respectively. The relation coefficient between QRS interval and ejection fraction, LVEDd, LVEDs, and average Sm were -0.292 （p〈0.01）, 0.364（P〈0. 001 ）, 0.373 （p〈0.001）,and-0.361 （p〈0.01）, respectively. There were no relationship between QRS interval and the E/A, and the average Em. The area under the receiver-operating curve for the average Sm to predict QRS interval ≥ 120ms were 88.9%, 75.0% when the average Sm was 3.38m/s. Conclusions In patients with chronic heart failure, The QRS interval in patients with systolic dysfunction was longer than those with diastolic dysfunction, the relationship between QRS interval and systolic function was more closely.