ROC曲线分析心电图对急性左心衰患者住院期间预后评价

ROC curve in evaluation of ECG for predicting prognosis of acute left heart failure patients in hospital

目的分析体表心电图QRS波时限、QTc间期动态变化对急性左心衰患者预后的预测价值。方法测量221例急性左心衰住院患者(NYHA心功能Ⅳ级)发作6 h内、首检后24及72 h的体表心电图QRS波时限、QTc间期和血浆BNP水平,并计算QRS波时限变化率、QTc间期变化率和BNP水平变化率。测量患者胸骨旁左室长轴切面左室舒张末内径(LVEDD)和左室射血分数(LVEF)。根据患者出院时病情状况分为预后良好组、预后不良组及死亡组,ROC曲线和Logistic回归分析三组患者的各项观察指标,评价心电图QRS波时限和QTc间期变化对住院急性左心衰患者预后的预测价值。结果心电图QRS波时限和QTc间期变化各组三个时点依次下降,差异具有统计学意义,变化趋势同血浆BNP水平。回归分析和ROC曲线显示72 h血浆BNP水平及72 h血浆BNP、QRS、QTc变化率对住院期间预后预测有较高的灵敏度和特异度。结论心电图QRS波时限及QTc间期的变化对左心衰患者住院期间预后具有较好的预测价值。

【Objective】To investigate the value of QRS prolongation and QTc duration on standard ECG in predicting the prognosis of the acute left heart failure（ALHF） patients in the hospital.【Methods】Serum B-type natriuretic peptide（BNP） level, QRS and QTc duration on 12-lead ECG were measured at baseline, after 24 and 72 hours in 221 consecutive patients with ALHF. The descending rates of BNP, QRS and QTc duration at different time points were calculated. The left ventricular end-diastolic diameter（LVEDD） and the left ventricular ejection fraction（LVEF） were measured by echocardiography. The patients were divided into three groups according to NYHA classification when the patients left hospital： good-prognosis group（NYHA improved 〉 II）, poor-prognosis group（NYHA improved 〈 I） and death group. Then the correlative indexes for different diagnosis of ALHF were analyzed by logistic regression. The death risk for the patients was analyzed by ROC curve. 【Results】Dynamic observation at three measuring points demonstrated QRS duration and QTc interval had statistically significant downward trends in the good-prognosis group; and there was no obvious difference in the poor-prognosis group or the death group. Regression analysis showed that four variables： BNP3, RATEBNP3, RATEQRS3 and RATEQTc3, had statistically significant effects on the prognosis of the patients with acute left heart failure. ROC curve showed the four variables had better predictive sensitivity and specificity for the prognosis of ALHF.【Conclusion】QRS duration and QTc interval have a good predictive value for the prognosis of patients with ALHF.