T波峰末间期对慢性收缩性心力衰竭患者预后的预测价值

The prognostic value of T peak to end interval in patients with chronic systolic heart failure

目的探讨T波峰末间期(TpTe)对慢性收缩性心力衰竭(简称心衰)患者预后的预测价值。方法回顾性调查和分析湖北地区8地市12家三级甲等医院2000年至2010年心衰住院患者临床资料,所有患者电话随访。根据TpTe四分位间距分为≥114 ms、88～113 ms、68～87 ms和≤67 ms组。单因素Kaplan-Meier曲线分析TpTe各组总死亡、心血管病死亡、心衰死亡、和心源性猝死有差异性。多因素Cox生存分析确认心衰患者不同预后的危险因素。受试者工作特征曲线(ROC曲线)分析TpTe、槡TpTe/RR是否增加预测的灵敏度和特异度。结果①共11067例患者纳入本次研究。将性别、年龄、心率、左室射血分数、病因、肾功能、心房颤动及治疗措施等指标加入多因素Cox回归分析,发现TpTe延长是总死亡、心血管病死亡和心衰死亡增加的独立危险因素,风险(95%CI,P)分别为1.002(1.001～1.002,<0.01)、1.002(1.001～1.003,<0.01)和1.002(1.001～1.003,<0.01);②ROC曲线分析发现不包含QTc、TpTe和槡TpTe/RR的预测模型预测总死亡、心血管病死亡、心衰死亡和心源性猝死的响应率分别为79.30%(Chic-square 1 893.25,P<0.01)、72.20%(Chic-square 2 771.33,P<0.01)、73.90%(Chic-square 2998.21,P<0.01)和71.90%(Chic-square 323.07,P<0.01)。分别加入QTc、QTc和TpTe、QTc和槡TpTe/RR的模型不增加预测模型的灵敏度和特异度。结论虽然TpTe延长增加慢性收缩性心衰患者的死亡风险,但不增加预测的灵敏度和特异度。

Objective To determinate the prognostic value of T peak to end interval （TpTe） in patients with chronic systolic heart failure （CSHF）. Methods Patients in-hospital from 12 hospitals of Hubei province in China, with diagno- sis of CSHF and left ventricular ejection fraction 〈 0.50 were enrolled. Patients were divided into four TpTe groups accord- ing to the M 25%-75%. All patients were followed up by telephone contact. The Kaplan-Meier curves were constructed to explore the difference among TpTe groups. Univariate and multivariate Cox regression analyses were then used on selecting demographic and clinical variables predicting the all-cause mortality, cardiovascular mortality, heart failure （HF） mortality and sudden cardiac death （SCD）. The receiver operating characteristic （ROC） curves were then developed to assess the incremental additive information of TpTe. Results （1）Over5.8±1.8 years follow-up, 3639 （32.9%） patients died.（2） The prolongation of TpTe was the independent risk factor of all-cause mortality, cardiovascular mortality and HF mortality （the OR, 95%CI, P is 1.002,1.001-1.002, 〈0.01; 1.002,1.001-1.003, 〈0.01 and 1.002,1.001-1.003, 〈0.01, respectively）. （3）The ROC curves showed the predicting models without QTc and TpTe were very significant predictors, with 79.30% （Chic-square 1 893.25, P〈0.01）, 72.20% （Chic- square 2 771.33, P〈0.01）, 73.90% （Chic-square 2 998.21 ,P〈0.01） and 71.90% （Chic-square 323.07, P 〈 0.01 ） observed responses concordant with all-cause mortality, eardiovascular mortality, HF mortality and SCD. While the model with TpTe did not increase the sensitivity or specificity. Conclusions TpTe dose not increase the sensitivity or specificity in predicting the prognosis of patients with CSHF.