心电图额面QRS-T夹角、QRS波时限与慢性心力衰竭患者心功能及预后的关系

Relationships between frontal QRS-T angle,QRS duration and cardiac function and prognosis in patients with chronic heart failure

目的探讨心电图额面QRS-T夹角、QRS波时限与慢性心力衰竭(CHF)患者心功能和预后的关系。方法选择161例CHF患者为CHF组,根据美国纽约心脏病协会(NYHA)心功能分级将其分为Ⅱ级组(57例)、Ⅲ级组(59例)、Ⅳ级组(45例);同期选择健康志愿者62例为对照组。收集患者病历资料,包括超声心动图指标[左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)]、血生化指标[血脂(甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇)和空腹血糖]、N端B型利钠肽前体(NT-proBNP);各组均接受十二导联心电图检查,记录额面QRS-T夹角、QRS波时限。出院后随访12个月,记录随访期间主要心血管不良事件(MACE)发生情况,将患者分为MACE组35例、非MACE组126例。Pearson相关法分析额面QRS-T夹角、QRS波时限与NYHA分级、心功能指标的相关性;多因素Logistic回归分析CHF患者发生MACE的影响因素;受试者工作特征曲线分析额面QRS-T夹角、QRS波时限预测CHF患者发生MACE的价值。结果CHF组额面QRS-T夹角、QRS波时限、LVESD、LVEDD均高于对照组(P均<0.05),LVEF低于对照组(P<0.05)。Ⅱ级组、Ⅲ级组、Ⅳ级组额面QRS-T夹角、QRS波时限、LVESD、LVEDD逐渐升高,LVEF逐渐降低,各组比较差异均有统计学意义(P均<0.05)。CHF组额面QRS-T夹角、QRS波时限与LVESD、LVEDD均呈正相关(P均<0.05),与LVEF均呈负相关(P均<0.05)。MACE组、非MACE组年龄、NYHA分级、LVEF、血清NT-proBNP水平、额面QRS-T夹角、QRS波时限比较差异均有统计学意义(P均<0.05)。NYHAⅣ级、高水平NT-proBNP、大额面QRS-T夹角、长QRS波时限是CHF患者发生MACE的危险因素(P均<0.05)。NT-proBNP、额面QRS-T夹角、QRS波时限联合预测CHF患者发生MACE的曲线下面积大于三者单独预测(P均<0.05)。结论额面QRS-T夹角增大和QRS波时限延长与CHF患者心功能下降及MACE发生有关,二者可预测CHF患者预后不良。

Objective To investigate the relationships between frontal QRS-T angle,QRS duration and cardiac function and prognosis in patients with chronic heart failure(CHF).Methods Totally 161 CHF patients were selected as the CHF group,and were divided into Class II group(57 cases),Class III group(59 cases),and Class IV group(45 cases)according to the New York Heart Association(NYHA)classification;62 healthy volunteers were selected as the control group during the same period.Patients'medical records were collected,including echocardiographic indicators[left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD),and left ventricular ejection fraction(LVEF)],blood biochemical indicators[blood lipids(triglycerides,total cholesterol,high-density lipoprotein cholesterol,and low-density lipoprotein cholesterol)and fasting blood glucose],and N-terminal pro-B type natriuretic peptide(NT-pro BNP).Each group underwent twelve lead electrocardiogram examination,and we recorded the frontal QRS-T angle and QRS duration.After discharge,patients were followed up for 12 months by phone or outpatient service to record the occurrence of major adverse cardiac events(MACE),and then the patients were divided into the MACE group of 35 cases and non-MACE group of 126 cases.Pearson correlation method was used to analyze the correlations between frontal QRS-T angle,QRS duration,NYHA grading,and cardiac function indicators.Multivariate Logistic regression analysis was used to investigate the influencing factors for MACE in CHF patients.The value of frontal QRS-T angle and QRS duration in predicting MACE in CHF patients was analyzed by the receiver operating characteristic(ROC)curve.Results The frontal QRS-T angle,QRS duration,LVESD,and LVEDD in the CHF group were higher than those in the control group(all P<0.05),while LVEF was lower than that in the control group(P<0.05).The frontal QRS-T angle,QRS duration,LVESD and LVEDD gradually increased in the ClassⅡ,ⅢandⅣgroups,while LVEF gradually decreased,and the differences were statistically significant between groups(all P<0.05).The frontal QRS-T angle and QRS duration in the CHF group were positively correlated with LVESD and LVEDD(all P<0.05),and were negatively correlated with LVEF(all P<0.05).There were statistically significant differences in age,NYHA grading,LVEF,serum NT-pro BNP levels,frontal QRS-T angle,and QRS duration between the MACE and non-MACE groups(all P<0.05).NYHA grade IV,high-level NT-pro BNP,large frontal QRS-T angle,and long QRS duration were risk factors for MACE in CHF patients(all P<0.05).The area under the curve of the combination of NT-pro BNP,frontal QRS-T angle,and QRS duration in predicting MACE in CHF patients was greater than that of the three alone(all P<0.05).Conclusion The increase in frontal QRS-T angle and the prolongation of QRS duration are associated with decreased cardiac function and MACE in CHF patients,both of which can predict poor prognosis in CHF patients.