平面QRS-T夹角与射血分数保留的心力衰竭心血管事件的相关性

Association of the planar QRS-T angle with prognosis in heart failure with preserved ejection fraction

目的:评价平面QRS-T夹角与HF-PEF患者心血管事件的相关性。方法:纳入确诊为HF-PEF的患者193例,按平面QRS-T夹角分为三个亚组,0～50°为组1,50°～90°为组2,90°～179°为组3;所有入选者均常规行12导联心电图检查,年龄、性别构成、病史,NYHA心功能分级和B型脑钠肽(BNP)等各项实验室检查等结果。结果:193例患者中,男93例,年龄(77±12)岁,QRS-T夹角96°±20°;女100例,年龄(76±10)岁,QRS-T夹角106°±20°。组1、组2心血管事件发生率比较,差异无统计学意义[45. 8%(27/59)比42. 4%(28/66),χ2=0. 141,P> 0. 05],组3的心血管事件发生率高于组1与组2,差异有统计学意义[分别为77. 9%(53/68)比45. 8%(27/59),χ2=14. 03; 77. 9%(53/68)比42. 4%(28/66),χ2=17. 67,均P <0. 05]。多因素Cox回归分析表明,在校正BNP、e GFR、NYHA心功能分级后,QRS-T夹角(HR=1. 012,95%CI:1. 006～1. 017,P <0. 05)是心血管事件的独立危险因素。结论:平面QRS-T夹角>90°是HF-PEF患者不良预后的独立危险因素,对其预后的判断有一定的价值。

Objective To determine the relationship belween planar QRS - T angle and cardiovascular events in patients with HF - PEF. Method A total of 193 patients with HF - PEF were enrolled in this study. They were divided into three subgroups ac- cording to the QRS - T angle ： group 1 （ 0 - 50°） , group 2 （ 50 ° - 90° ）, and group 3 （ 90° - 179 ° ）. All participants were routinely performed 12 -lead electrocardiogram and other laboratory- tests such as age, gender, medical history-, NYHA cardiac functional grading and BNP. Results Among the 193 patients,93 were male[ mean age： （77 ± 12） years] ;the mean QRS -T angle was 96° ±20°. The number of females[ mean age： （76 ± 10） years] was 100,and the mean QRS -T angle was 106° ±20°. There was no difference in the incidence of cardiovascular events between group 1 and group 2 [45.8% （27/59） vs. 42. 4% （28/ 66） ,X2 = 0. 141, P 〉 0. 05 ]. The incidence of cardiovascular events in group 3 was higher than that of group 1 and group 2 [ 77.9% （53/68） vs. 45.8% （27/59） ,X2 = 14. 03 ;77.9% （53/68） vs. 42. 4% （28/66） ,X2 = 17. 67, P 〈 0. 05 for all com- parisons]. Multivariable Cox regression analysis showed that QRS - T angle （ HR = 1. 012,95% CI ： 1. 006 - 1. 017 ,P 〈 0. 05 ） was independently associated wifll cardiovascular events, even after adjusting BNP, eGFR and NYHA cardiac functional grad- ing. Conclusion Planar QRS - T angle 〉 90 ° is an independent risk factor for poor prognosis in patients with HF - PEF.