心电图在急性肺栓塞患者右心功能不全和预后评估中的价值

Value of electrocardiogram in the assessment of right ventricular dysfunction and prognosis in patients with acute pulmonary embolism

目的探讨心电图在急性肺栓塞(APE)患者右心功能不全和预后评估中的价值。方法回顾性分析148例确诊APE患者的临床资料,根据超声心动图结果分为右心功能正常组(NRVD组,115例)和右心功能不全组(RVD组,33例)。分析心电图与APE患者右心功能不全及预后的关系。采用多因素Cox回归分析评估APE患者死亡的独立危险因素。结果 RVD组患者年龄、肌钙蛋白I、乳酸浓度、Hb水平、心力衰竭(心衰)比例、电轴右偏比例、右束支传导阻滞比例、S1Q3T3比例、心房颤动比例、V1~V3导联T波倒置比例、按心率校正的QT间期、aVR导联ST段抬高比例及住院病死率均高于NRVD组(P<0.05)。多因素logistic回归分析显示,心衰、S1Q3T3、V1~V3导联T波倒置与APE患者右心功能不全有关(OR=10.703、22.997、5.838,P<0.05)。Kaplan-Meier生存曲线显示,NRVD组患者累计生存率高于RVD组(80.1%vs.62.5%)(P<0.01)。多因素Cox回归分析显示,在调整了性别、年龄、心衰、S1Q3T3、V1~V3导联T波倒置后,S1Q3T3是APE患者死亡的独立危险因素[HR=6.257,95%CI(1.457~26.874),P<0.05]。结论心电图S1Q3T3和V1~V3导联T波倒置与APE患者右心功能不全有关;S1Q3T3是APE合并右心功能不全患者死亡的独立危险因素。

Objective To explore the value of electrocardiogram(ECG) in the assessment of right ventricular dysfunction and prognosis in the patients with acute pulmonary embolism(APE).Methods The clinical data of 148 patients diagnosed as APE were restropectively analyzed,who were divided into two groups of A(with normal right ventricular function,115 cases) and B(with right heart dysfunction,33 cases).Multivariate Cox regression analysis was used to assess independent risk factors for death in the patients with APE.Results Compared with group A,the average age,cTNI,lactate concentration,Hb level,QTc,the percentages of the patients with heart failure,right axis deviation,RBBB,S1 Q3 T3,atrial fibrillation,V1-V3 lead T wave inversion,aVR lead ST segment elevation,and hospitalization mortality were higher in group B(P<0.05).The heart failure,S1 Q3 T3 and V1-V3 lead T wave inversion were closely associated with right heart dysfunction in the patients with APE(OR=10.703,22.997 and 5.838,P<0.05).Kaplan-Meier survival curve showed that the cumulative survival rate of group A was higher than that of group B(80.1% vs.62.5%)(P<0.01).S1 Q3 T3 was an independent risk factor for death in APE patients after adjustment for gender,age,heart failure,S1 Q3 T3,and V1-V3 lead T wave inversion [HR=6.257,95% CI(1.457-26.874),P<0.05].Conclusion ECG S1 Q3 T3 and V1-V3 lead T wave inversion are closely associated with right heart dysfunction in the patients with APE.ECG S1 Q3 T3 is an independent risk factor for death in APE patients with right ventricular dysfunction.