射血分数保留心力衰竭患者体表心电图QRS-T夹角与心室重构的相关性及对预后预测价值

Correlation between the QRS-T angle of ECG and ventricular remodelling in patients with heart failure with preservation of ejection fraction and its prognostic value

目的探讨射血分数保留心力衰竭(HFp EF)患者体表心电图QRS-T夹角与心室重构的相关性及对预后的预测价值。方法选取2018年1月至2020年1月于首都医科大学大兴教学医院收治的100例HFp EF患者作为研究组,以年龄、性别为匹配条件选取同期于本院进行体检的48例正常者为对照组。所有入选者均常规行12导联心电图、超声心动图及实验室检查,比较两组心电图QRS-T夹角与心室重构指标左心室重量指数(LVMI)、平均室壁应力(MWS)、脑钠肽(BNP)差异,采用Pearson相关性分析HFp EF患者QRS-T夹角与LVMI、MWS、BNP的关系。随访入院至出院后1年,将HFp EF患者根据预后是否发生全因死亡和终点事件(心功能恶化、再发心肌梗死、伴血流动力学障碍的心律失常、伴心电图缺血改变的心绞痛等所致的再次入院和死亡)分为发生组和未发生组,采用单因素及多因素Logistic回归分析影响HFp EF发生不良事件的危险因素,绘制受试者工作特征曲线(ROC)分析体表心电图QRS-T夹角对HFp EF患者发生不良事件的预测价值。结果研究组QRS-T夹角、LVMI、MWS、BNP均大于对照组(P<0.05);Pearson相关性分析显示,HFp EF患者QRS-T夹角与LVMI、MWS、BNP均呈正相关(r=0.715、0.473、0.869,P均<0.05);单因素分析显示,不良事件发生组患者BNP、CRP、QRS-T夹角、LVMI、MWS均大于未发生组患者(P<0.05);多因素Logistic回归分析显示,BNP、QRS-T夹角及LVMI均是预测HFp EF患者发生不良事件的独立预测因子(P<0.05);ROC曲线分析显示,预测HFp EF患者预后的QRS-T夹角的最佳截断点为90°,曲线下面积(AUC)为0.808(95%CI:0.662~0.937),敏感度为84.21%(48/57),特异度为86.05%(37/43)。结论HFp EF患者体表心电图QRS-T夹角与心室重构关系密切,并对患者预后具有良好预测价值。

Objective To investigate the correlation between the QRS-T angle and ventricular remodelling of patients with heart failure with preserved ejection fraction(HFpEF)and its predictive value.Methods A total of 100 HFpEF patients admitted to the hospital from January 2018 to January 2020 were selected as the study group,and 48 regular patients who underwent physical examinations in our hospital during the same period were selected as the control group based on age and gender matching conditions.All selected candidates underwent routine 12-lead ECG,echocardiography and laboratory examinations.Compare the differences between the QRS-T included angle of ECG and the left ventricular mass index(LVMI),mean wall stress(MWS),and B-type brain natriuretic peptide(BNP)of ventricular remodelling index between the two groups.Pearson correlation was used to analyze the relationship between QRS-T angle and LVMI,MWS,BNP in HFpEF patients.Patients with HFpEF were followed up from admission to 1 year after discharge and were divided into an occurrence group and a non-occurrence group according to whether they had all-cause death and endpoint events(readmission and death due to worsening cardiac function,recurrent myocardial infarction,arrhythmias with hemodynamic disturbances,angina pectoris with ischemic changes in the electrocardiogram)based on their prognosis.Single-factor and multivariate Logistic regression analyses were used to analyze the risk factors of adverse events in HFpEF,and the receiver operating characteristic curve(ROC)was drawn to study the predictive value of the QRS-T angle of the body surface ECG adverse events in HFpEF patients.Results The QRS-T angle,LVMI,MWS,and BNP of the study group were more significant than those of the control group(P<0.05).Pearson correlation analysis showed that the QRS-T angle of HFpEF patients was positively correlated with LVMI,MWS,and BNP(r=0.715,0.473,0.869,P<0.05).Univariate analysis showed that the BNP,CRP,QRS-T angle,LVMI,and MWS of patients in the adverse event group were more significant than those in the non-event group(P<0.05).Multivariate logistic regression analysis showed that BNP,QRS-T included angle and LVMI were independent predictors of adverse events in patients with HFpEF(P<0.05).ROC curve analysis shows that the best cut-off point of QRS-T angle for predicting the prognosis of HFpEF patients was 90°,the area under the curve(AUC)was 0.808(95%CI:0.662~0.937),the sensitivity was 84.21%(48/57),and the specificity was 86.05%(37/43).Conclusion The QRS-T angle of the body surface electrocardiogram of HFpEF patients was closely related to ventricular remodelling and had a good predictive value for the prognosis of patients.