老年HFpEF患者QRS-T夹角的意义

Significance of QRS-T angle in elderly patients with heart failure with preserved ejection fraction

目的观察老年射血分数保留心力衰竭(HFp EF)患者的心电图平面QRS-T夹角与心功能NYHA分级及预后的关系。方法选取老年HFp EF患者204例,按照NYHA心功能分级标准分为3组:心功能Ⅱ级组(n=64)、Ⅲ级组(n=85)、Ⅳ级组(n=55)。同期选取心功能正常患者74例作为对照组。所有患者于入院时行心电图检查记录平面QRS-T夹角并随访1年。结果 HFp EF组QRS-T夹角(87.48°±23.25°)、血浆BNP水平(348.4±169.03pg/ml)以及发生预后不良比例(36.8%)高于对照组(38.95°±16.89°、58.35±17.52pg/ml、8.1%,p<0.05),随NYHA心功能分级增加,QRS-T夹角和血浆BNP水平逐渐升高(p<0.05)。预后不良患者QRS-T夹角、血浆BNP水平高于预后良好患者(p<0.05)。结论老年HFp EF患者的QRS-T夹角与心功能NYHA分级及预后密切相关。通过心电图检测平面QRS-T夹角可以用于辅助诊断HFp EF并判断其心力衰竭的严重程度以及评估预后。

Objective To observe the relationship between plane QRS-T angle and NYHA cardiac function and prognosis in elderly patients with heart failure with preserved ejection fraction(HFp EF). Methods A total of 204 elderly patients with HFp EF was divided into three groups according to the NYHA cardiac function classification standard(64 with NYHA class Ⅱ, 85 with NYHA class Ⅲ, 55 with NYHA class Ⅳ) and 74 with normal cardiac function were enrolled in control group. Plane QRS-T angle was detected with routine electrocardiogram on admission for every subject. Results The QRS-T angle(87.48°±23.25°), BNP(348.4±169.03 pg/ml) and the incidence of poor prognosis(36.8%) in HFp EF group was significantly larger than those in control group(38.95°±16.89°,58.35±17.52 pg/ml, 8.1%, p<0.05). The QRS-T angle and the level of BNP increased gradually with the increase of cardiac function grade(p<0.05). The QRS-T angle and BNP in poor prognosis group was larger than those in good prognosis group(p<0.05). Conclusions QRS-T angle of elderly HFp EF patients has a close relationship with NYHA cardiac function and prognosis. Plane QRS-T angle can be used to assist in the diagnosis of HFp EF and the determination of the severity and prognosis of heart failure.