冠心病并发急性心力衰竭患者心电图QRS波群时限与心功能和预后的相关性

Correlation between Time Limit of ECG QRS Complex with Cardiac Function and Prognosis in Patients with Coronary Heart Disease Complicated by Acute Heart Failure

目的研究冠心病并发急性心力衰竭患者心电图QRS波群时限与心功能和预后的相关性。方法回顾性分析2015年5月—2020年5月收治的110例冠心病并发急性心力衰竭的临床资料。将QRS波群时限≥110 ms者纳入A组(61例);QRS波群时限<110 ms者纳入B组(49例),比较两组纽约心脏协会(NYHA)心功能分级、左心室射血分数(LVEF)及血浆N-末端脑钠肽前体(NT-proBNP)水平。影响冠心病并发急性心力衰竭患者预后不良的危险因素采用多因素Logistic回归分析。结果A组NYHA心功能Ⅱ级构成比显著低于B组,Ⅳ级构成比显著高于B组(P<0.05);且A组LVEF低于B组,血浆NT-proBNP水平高于B组(P<0.01)。对所有患者进行6个月随访,其中预后良好83例(75.45%),预后不良27例(24.55%)。预后不良组年龄、NYHA心功能分级、QRS波群时限、血浆NT-proBNP水平、是否合并高脂血症、LVEF与预后良好组比较差异均有统计学意义(P<0.01)。年龄≥55岁、NYHA心功能Ⅳ级、QRS波群时限≥110 ms、NT-proBNP≥300 pg/ml、合并高脂血症、LVEF<35%是冠心病并发急性心力衰竭患者预后不良的独立危险因素(P<0.05)。结论心电图可作为临床筛查冠心病并发急性心力衰竭的首选检查方法,QRS波群可有效反映心肌细胞的电生理状况,可作为评估患者心功能和预后的客观指标;QRS波群时限延长,则表明患者心功能和预后差。

Objective To study correlation between time limit of electrocardiography(ECG)QRS complex with cardiac function and prognosis in patients with coronary heart disease(CHD)complicated by acute heart failure(AHF).Methods Clinical data of 110 patients with CHD complicated by AHF admitted between May 2015 and May 2020 were retrospectively analyzed.Patients with time limit of QRS complex equal or more than110 ms were included in group A(n=61),while patients with time limit of QRS complex less than 110 ms were included in group B(n=49).Levels of classification for cardiac function by New York Heart Association(NYHA),left ventricular ejection fraction(LVEF)and plasma N-terminal pro-brain natriuretic peptide(NT-proBNP)were compared in two groups.Multivariate logistic regression analysis was used to analyze risk factors affecting poor prognoses of patients with CHD complicated by AHF.Results In group A,the constituent ratio of NYHA grade Ⅱ was significantly lower than that in group B,while the constituent ratio of gradeⅣwas significantly higher than that in group B(P<0.05);LVEF level was significantly lower than that in group B,while NT-proBNP level was significantly higher than that in group B(P<0.01).All the patients were followed up for 6 months,among that there were 83 patients(75.45%)with good prognoses and 27 patients(24.55%)with poor prognosis.There were statistically significant differences in age,classification for cardiac function by NYHA,time limit of QRS complex,plasma NT-proBNP level,whether or not combination of hyperlipidemia and LVEF between poor prognosis and good prognosis groups(P<0.01).The age equal or more than 55 years old,NYHA grade Ⅳ,time limit of QRS complex equal or more than 110 ms,NT-proBNP level equal or more than 300 pg/ml,combined with hyperlipidemia and LVEF less than 0.35%were independent risk factors affecting poor prognosis in patients with CHD complicated by AHF(P<0.05).Conclusion Electrocardiogram may be used as the first choice for clinical screening of AHF,and QRS complex group may effectively reflect the electrophysiological status of myocardial cells,and may be used as an objective indicator to evaluate the patients'cardiac function and prognoses.The longer time limit of QRS complex duration indicates poor cardiac function and prognosis.