平面QRS-T夹角对急性心力衰竭综合征不良预后的预测价值

Prognostic value of planar QRS-T angle in patients with poor outcomes of acute heart failure syndrome

目的：通过分析平面QRS-T夹角与急性心力衰竭综合征（acute heart failure syndromes,AHFS）近、远期不良结局相关性评价其预后预测价值。方法：2所中心医院125例AHFS患者,根据入院首次心电图平面QRS-T夹角将患者分为〈90°组和≥90°组。采集患者入院首次病史、体征、辅助检查等基线变量,比较两组患者基线参数差异。随访入院至出院后30d（近期）和1年（远期）不良结局发生情况,Kaplan-Meier（K-M）生存分析进行2组近、远期不良预后发生率差异比较,Cox回归模型多因素分析平面QRS-T夹角≥90°与不良预后关系。结果：所有患者平均平面QRS-T夹角为（116.5±46.9）°。≥90°组96例患者中远期不良结局92例,其中50例为近期不良结局患者。〈90°组29例患者中远期不良结局19例,其中8例为近期不良结局患者。与〈90°组患者相比,≥90°组心影增大、V1导联终末电势（PtfV1）≤-0.04 mm·s更多见,并且有更低的肾小球滤过率估计值（eGFR）和左室射血分数（LVEF）、更高的CK-MB和肌钙蛋白I。K-M曲线：两组近、远期不良结局发生率曲线差别均有统计学意义。经PtfV1≤-0.04mm·s、心影增大、eGFR、LVEF、CK-MB和肌钙蛋白I多因素校正后平面QRS-T夹角≥90°与近期不良结局发生率相关性无统计学意义（HR：1.78,95%CI：0.75~4.22,P=0.19）,但仍是远期不良预后的独立预测因素（HR：2.04,95%CI：1.18~3.56,P=0.01）。结论：平面QRS-T夹角≥90°是本研究AHFS队列远期不良预后的独立预测因素,尚不能认为是近期不良预后的预测因素。

Objective：To assess the prognostic value of planar QRS-T angle in patients with acute heart failure syndrome（AHFS）by analyzing poor outcomes from short-term and long-term follow up.Method：The 125 AHFS patients from 2hospitals were enrolled.These patients were divided into less than 90degrees（〈90°）group and greater than or equal to 90degree（≥90°）group,based on their first ECG result after admitting to hospital.Poor outcomes were recorded during the 30days（short-term）and 1year（long-term）follow-up.Kaplan-Meier（K-M）curves were used to compare the difference of short-term and long-term poor outcomes from the 2groups.A Cox proportional hazards regression was used as multivariable model to assess the relationship of the planar QRS-T angle≥90°with short and long term outcomes.Result：Mean degrees of planar QRS-T angle were 116.5±46.9°of all patients.There were 92long-term cases of poor outcomes out of 96in≥90°group,and 50 of these cases were also short term poor outcomes.In comparison,there were 19long-term cases of poor outcomes out of 29 in 〈90°group,and 8of these cases were also short term poor outcomes.Patients with planar QRS-T angle ≥90°were more likely have large heart shadow,more P wave terminal force in lead V1（PtfV1）≤-0.04mm·s,lower estimated glomerular filtration rate（eGFR）,lower left ventricular ejection fraction（LVEF）,higher CK-MB and Troponin I.K-M curves for endpoint showed that there were significant difference between ≥90°group and 〈90°group on both short-term and long-term poor outcomes.After multivariable adjustment by enlarge heart shadow,PtfV1≤-0.04mm·s,eGFR,LVEF,CK-MB,and Troponin I in Cox model,the planar QRS-T angle≥90°remain a significant predictor of long-term poor ourcomes（HR：2.04,95%CI：1.18~3.56,P=0.01）,but there was no statistical significance in short-term poor outcomes（HR：1.78,95%CI：0.75~4.22,P=0.19）.Conclusion：Planar QRS-T angle≥90°is a significant predictor of long-term poor outcomes in our AHFS patients cohort;however,it is not a predictor of short-term poor outcomes.