QRS波时限与老年慢性心力衰竭患者分类、心功能及预后的相关性

Correlation of QRS Complex Duration with Classification, Cardiac Function and Prognosis in Older Adults with Chronic Heart Failure

目的 探究QRS波时限与老年慢性心力衰竭(CHF)分类、心功能及预后的相关性。方法 选择2018年10月~2019年10月收治的164例老年CHF患者作为CHF组,根据左室射血分数(LVEF)分为收缩性心衰组(LVEF<45.00%,91例)、舒张性心衰组(LVEF≥45.00%,73例);另选择100例健康人群为对照组。受试者均进行超声心动图和12导联标准心电图检查,记录QRS波时限、超声心动图指标[LVEF、左心室舒张末内径(LVEDD)、左心室收缩末内径(LVESD)、室间隔厚度(IVST)、左室后壁厚度(LVPWT)]。随访时间截止至出院后12个月,统计终点事件(死亡和急性心力衰竭)的发生情况。结果 CHF组QRS波时限、LVEDD、LVESD、IVST、LVPWT大于对照组(P<0.05),LVEF小于对照组(P<0.05);收缩性心衰组QRS波时限、LVEDD、LVESD大于舒张性心衰组(P<0.05),LVEF小于舒张性心衰组(P<0.05)。Pearson相关系数分析显示,QRS波时限与LVEF呈负相关(r=-0.612,P<0.05),与LVEDD、LVESD呈正相关(r=0.435、0.473,P<0.05)。Cox比例风险模型分析显示,QRS波时限与老年CHF患者终点事件的发生独立相关(P<0.05)。受试者工作特征曲线分析QRS波时限预测老年CHF患者终点事件的曲线下面积为0.886,灵敏度和特异度分别为85.29%、80.00%。结论 老年CHF患者QRS波时限明显延长,与CHF分类、心功能、预后均存在密切关系,QRS波时限延长对患者预后具有预测价值。

Objective To explore the correlation of QRS complex duration with classification, cardiac function and prognosis in older patients with chronic heart failure(CHF).Methods A total of 164 older CHF patients admitted to hospital from October 2018 to October 2019 were assigned to a CHF group.According to left ventricular ejection fraction(LVEF),the patients were subdivided into a systolic heart failure group(LVEF<45.00%,91 cases) and a diastolic heart failure group(LVEF≥45.00%,73 cases).Another 100 healthy people were assigned to a control group.All individuals underwent echocardiographic and standard 12-lead electrocardiograms(ECG) examination.The QRS complex duration and echocardiographic parameters including LVEF,left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),interventricular septal thickness(IVST),and left ventricular posterior wall thickness(LVPWT) were recorded.The follow-up period was up to 12 months after discharge, and the occurrence of endpoint events(death and acute heart failure) was recorded.Results The QRS complex duration, LVEDD,LVESD,IVST,and LVPWT in the CHF group were more than those in the control group(P<0.05),and LVEF was lower than that in the control group(P<0.05).The QRS complex duration, LVEDD and LVESD in the systolic heart failure group were more than those in the diastolic heart failure group(P<0.05),and LVEF was lower than that in the diastolic heart failure group(P<0.05).Pearson correlation coefficient analysis showed that QRS complex duration was negatively correlated with LVEF(r=-0.612,P<0.05),and positively correlated with LVEDD and LVESD(r=0.435,0.473,P<0.05).Cox proportional hazards model showed that the duration of QRS complex was independently correlated with the occurrence of independent events in older CHF patients(P<0.05).Receiver operating characteristic(ROC) curve analysis showed that the area under the curve of QRS complex duration for predicting endpoint events in older CHF patients was 0.886,and the sensitivity and specificity were 85.29% and 80.00%,respectively.Conclusion The duration of QRS complex in older patients with CHF is significantly prolonged, which is closely related to CHF classification, cardiac function, and prognosis.The prolonged duration of QRS complex has predictive value for poor prognosis in patients with CHF.