心电图胸导联R波递增不良老年慢性心力衰竭患者的临床特征及预后

Clinical features and prognosis of elderly patients with chronic heart failure and poor R wave progression in precordial leads

目的探讨心电图胸导联R波递增不良(PRWP)老年慢性心力衰竭(CHF)患者的临床特征及预后。方法选取148例老年CHF患者为研究对象,分为观察组(合并PRWP,40例)和对照组(无PRWP,108例)。比较两组一般临床资料及临床预后情况。结果两组心力衰竭类型比较差异有统计学意义(P<0.01),观察组射血分数降低型心力衰竭(HFrEF)占比高而射血分数保留型心力衰竭(HFpEF)占比低。观察组纽约心脏病学会(NYHA)心功能分级明显高于对照组,6min步行距离明显低于对照组,左心室射血分数明显低于对照组,左心室舒张末期内径、左心室质量指数、左心室Tei指数、氨基末端B型脑钠肽前体高于对照组,差异均有统计学意义(P<0.05或0.01)。出院后随访1年,观察组终点事件总发生率为40.00%,显著高于对照组的25.00%、差异有统计学意义(χ^2=4.820,P<0.05)。PRWP是老年CHF患者预后不良的独立危险因素(OR=1.855,95%CI:1.527-4.560,P<0.05)。结论老年CHF患者PRWP通常与心脏收缩功能不全、左心室扩大及预后不良相关。

Objective To investigate the clinical characteristics and prognosis of elderly patients with chronic heart failure(CHF) and poor R wave progression(PRWP) in precordial leads.Methods A total of 148 elderly CHF inpatients admitted from March 2015 to March 2018 were enrolled and divided into observation group(with PRWP,n=40) and control group(without PRWP,n=108). The general clinical data and prognosis were compared between the two groups.Results Heart failure type was significantly different(P<0.01) in the two groups with more HFrEF and less HFpEF in observation group. NYHA grade was significantly higher and 6-minute walk distance significantly lower in observation group than in control group(P<0.05 or 0.01). Left ventricular(LV) ejection fraction was significantly lower,LV end-diastolic dimension,LV mass index,LV Tei index and NT-proBNP were significantly higher in observation group than in control group(P<0.05 or 0.01). During 1 year of follow-up after discharge,the incidence of end-point events in observation group was significantly higher than that in control group(40.00% vs. 25.00%,χ^2=4.820,P<0.05). Logistic regression analysis showed that PRWP was an independent risk factor for poor prognosis in elderly CHF patients(OR=1.855,95%CI: 1.527-4.560,P<0.05).Conclusion In elderly CHF patients PRWP is usually related to left ventricular systolic dysfunction,left ventricular dilation and poor prognosis.