QRS波对严重三支血管病变冠心病患者心功能不全的预测价值

Predictive value of QRS wave for cardiac insufficiency in CHD patients with severe triple-vessel coronary disease

目的:研究静息心电图QRS波对严重三支血管病变冠心病患者心功能不全的预测价值。方法:依据LVEF,于我院治疗的严重三支血管病变的168例冠心病患者被分为心功能正常组(LVEF≥50%,116例)和心功能不全组(LVEF<50%,52例)。比较两组一般临床资料,分析静息心电图QRS波对这类患者心功能不全的预测价值及这类患者心功能不全的影响因素。结果:与心功能正常组比较,心功能不全组年龄、心率(HR)、QRS波时限及碎裂QRS波(fQRS)、合并高血压比例均显著升高(P均<0.01)。ROC曲线分析显示,年龄、HR、QRS波时限预测严重三支血管病变冠心病患者心功能不全的曲线下面积分别为0.662、0.792、0.669,灵敏度分别为61.5%、69.2%、78.8%,特异度分别为65.5%、80.2%、49.1%。多因素Logistic回归分析显示,年龄≥65岁、HR≥74.5次/min、QRS波时限≥97.0 ms、fQRS、合并高血压是这类患者心功能不全的独立危险因素(OR=2.250~9.555,P<0.05或<0.01)。结论:年龄、HR、QRS波时限、fQRS、合并高血压为严重三支血管病变冠心病患者心功能不全的独立危险因素,且对其具一定的预测价值。

Objective:To study predictive value of resting ECG QRS wave for cardiac insufficiency in coronary heart disease(CHD)patients with severe triple-vessel coronary disease.Methods:According to LVEF,a total of 168 CHD patients with severe triple-vessel coronary disease treated in our hospital were divided into normal cardiac function group(LVEF≥50%,n=116)and cardiac insufficiency group(LVEF<50%,n=52).General clinical data were compared between two groups,and predictive value of resting ECG QRS wave for cardiac insufficiency in these patients and its influencing factors were analyzed.Results:Compared with normal cardiac function group,there were significant rise in age,heart rate(HR),QRS wave duration and percentages of fragmented QRS wave(fQRS)and hypertension in cardiac insufficiency group(P<0.01 all).ROC curve analysis indicated that areas under curve(AUC)of age,HR and QRS wave duration for predicting cardiac insufficiency in CHD patients with severe triple-vessel coronary disease was 0.662,0.792 and 0.669 respectively,sensitivity was 61.5%,69.2%and 78.8%respectively;specificity was 65.5%,80.2%and 49.1%respectively.Multivariate Logistic regression analysis indicated that age≥65 years old,HR≥74.5 beats/min,QRS duration≥97.0 ms,fQRS and hypertension were independent risk factors for cardiac insufficiency in these patients(OR=2.250~9.555,P<0.05 or<0.01).Conclusion:Age,HR,QRS wave duration,fQRS and hypertension are independent risk factors for cardiac insufficiency in patients with severe triple-vessel coronary disease,and possess certain predictive value for it.