LVEF与心电图QRS波时程比值对老年急性心力衰竭患者近期预后的预测分析

Prediction analysis of short-term prognosis of elderly patients with acute heart failure by ratio of LVEF and QRS wave duration of electrocardiogram

目的探讨左室射血分数(LVEF)与心电图QRS波时程(QRSd)比值(TEF)对老年急性心力衰竭(AHF)患者近期预后的预测价值。方法选择2019年2月—2022年12月本院收治的120例老年AHF患者作为观察组,另选同期120名老年健康志愿者作为健康组。两组均进行心电图检查,比较二者LVEF、QRSd、TEF。观察组随访3个月,统计预后不良发生率,分析其影响因素;绘制受试者工作特征(ROC)曲线分析TEF预测近期预后不良的价值。结果观察组LVEF、TEF均低于健康组(P<0.05),QRSd高于健康组(P<0.05);观察组近期预后不良发生率为24.14%,且年龄(OR=3.364,95%CI:2.252~4.475)、美国纽约心脏病协会(NYHA)Ⅲ~Ⅳ级(OR=5.296,95%CI:4.065~6.527)、合并糖尿病(OR=4.865,95%CI:3.618~6.111)、合并高脂血症(OR=4.958,95%CI:3.408~6.508)、合并高血压(OR=3.404,95%CI:2.220~4.588)、合并冠心病(OR=5.409,95%CI:3.954~6.863)、中性粒细胞/淋巴细胞比值(NLR)(OR=6.025,95%CI:4.393~7.658)、尿酸(UA)(OR=5.447,95%CI:3.849~7.044)、TEF(OR=0.598,95%CI:0.069~0.835)均是观察组近期预后不良的影响因素(P<0.05);TEF预测观察组近期预后不良的灵敏度、特异度、AUC分别为92.86%、92.05%、0.974,均高于NLR和UA(P<0.05)。结论AHF患者LVEF、TEF下降,QRSd升高,TEF等均可影响近期预后,且TEF预测近期预后不良的效能高于常规生化指标。

Objective To explore the predictive value of left ventricular ejection fraction(LVEF)to QRS duration(QRSd)ratio(TEF)in the short-term prognosis of elderly patients with acute heart failure(AHF).Methods 120 elderly patients with AHF admitted to the hospital from February 2019 to December 2022 were enrolled as observation group,and during the same period,120 elderly healthy volunteers were selected as health group.ECG examination was performed among all the population,and LVEF,QRSd and TEF were compared.The observation group was followed up for 3 months,and the incidence of poor prognosis was counted and its influencing factors were analyzed.Receiver operating characteristic(ROC)curve was drawn to analyze the value of TEF in predicting poor prognosis in the near future.Results LVEF and TEF in the observation group were lower than those in the healthy group(P<0.05),and QRSd was higher than that of the healthy group(P<0.05).The incidence of poor short-term prognosis in the observation group was 24.14%,and the age(OR=3.364,95%CI:2.252~4.475),NYHA ClassⅢ~Ⅳ(OR=5.296,95%CI:4.065~6.527),diabetes(OR=4.865,95%CI:3.618~6.111),hyperlipidemia(OR=4.958,95%CI:3.408~6.508),hypertension(OR=3.404,95%CI:2.220~4.588),coronary heart disease(OR=5.409,95%CI:3.954~6.863)neutrophil/lymphocyte ratio(NLR)(OR=6.025,95%CI:4.393~7.658),uric acid(UA)(OR=5.447,95%CI:3.849~7.044),and TEF(OR=0.598,95%CI:0.069~0.835)were all factors affecting the poor prognosis in the observation group(P<0.05).The sensitivity,specificity and AUC of TEF in predicting poor prognosis in the observation group were 92.86%,92.05%and 0.974 respectively,which were higher than those of NLR and UA(P<0.05).Conclusions Decrease of LVEF and TEF,increase of QRSd,TEF and other factors of patients suffering AHF can affect the short-term prognosis,and TEF is more effective than conventional biochemical indicators in predicting the short-term poor prognosis.