HrEF、TEF与心功能分级的相关性及其对冠心病新发心房颤动的预测价值

The correlation between HrEF,TEF and cardiac function classification and their predictive value for new onset atrial fibrillation in coronary heart disease

目的 探究左室射血分数(LVEF)与心率的比值(HrEF)、LVEF与心电图QRS波时程(QRSd)的比值(TEF)与心功能分级的相关性,并分析HrEF、TEF对冠心病(CHD)新发心房颤动(AF)的预测价值。方法 选取2020年10月至2022年8月于该院就诊的82例CHD患者作为研究对象,按照是否新发AF分为AF组(16例)和非AF组(66例),另根据美国纽约心脏病学会(NYHA)分级分为Ⅰ级组(10例)、Ⅱ级组(28例)、Ⅲ级组(37例)、Ⅳ级组(7例)。所有患者均进行LVEF及心电图检查,记录并比较Ⅰ~Ⅳ级组患者LVEF、QRSd、心率、HrEF、TEF,比较AF组与非AF组HrEF及TEF。采用Spearman相关分析LVEF、QRSd、心率、HrEF、TEF与NYHA分级的相关性。绘制受试者工作特征(ROC)曲线分析HrEF、TEF对CHD新发AF的预测价值。结果 QRSd、心率比较均为Ⅰ级组<Ⅱ级组<Ⅲ级组<Ⅳ级组,差异均有统计学意义(P<0.05)。LVEF、HrEF及TEF比较均为Ⅰ级组>Ⅱ级组>Ⅲ级组>Ⅳ级组,差异均有统计学意义(P<0.05)。Spearman相关分析结果显示,CHD患者LVEF、HrEF、TEF与NYHA分级均呈负相关(r=-0.518、-0.625、-0.634,P<0.05)。QRSd、心率与NYHA分级均呈正相关(r=0.513、0.527,P<0.05)。AF组HrEF、TEF均低于非AF组,差异均有统计学意义(P<0.05)。ROC曲线分析显示,2项指标联合预测CHD新发AF的曲线下面积(AUC)为0.874,高于HrEF(AUC为0.817)、TEF(AUC为0.718)单独预测。结论 HrEF、TEF与CHD患者心功能分级有相关性,且HrEF、TEF对CHD新发AF的预测价值较高,可为临床诊疗提供参考依据。

Objective To explore the correlation between left ventricular ejection fraction(LVEF) to heart rate ratio(HrEF),the LVEF to electrocardiogram QRS time history ratio(TEF) and cardiac function classification,and to analyze the predictive value of HrEF and TEF for new onset atrial fibrillation(AF) in coronary heart disease(CHD).Methods A total of 82 CHD patients treated in the hospital from October 2020 to August 2022 were selected as research objects,and they were divided into AF group(16 cases) and non-AF group(66 cases) according to the occurrence of new AF.In addition,according to New York College of Cardiology(NYHA) classification,they were divided into class Ⅰ group(10 cases),class Ⅱ group(28 cases),class Ⅲ group(37 cases),and class Ⅳ group(7 cases).LVEF and electrocardiogram examination were performed in all patients.LVEF,QRSd,heart rate,HrEF and TEF were recorded and compared in patients with class Ⅰ-Ⅳ,and HrEF,TEF were compared between AF group and non-AF group.Spearman correlation analysis was used to analyze the correlation between LVEF,QRSd,heart rate,HrEF,TEF and NYHA classification.The receiver operating characteristic(ROC) curve was drawn to analyze the predictive value of HrEF and TEF for new-onset AF of CHD.Results QRSd and heart rate were the class Ⅰ group < class Ⅱ group < class Ⅲ group < class Ⅳ group,and the differences were statistically significant(P<0.05).The LVEF,HrEF and TEF were the class Ⅰgroup > class Ⅱgroup > class Ⅲ group> class Ⅳ group,and the differences were statistically significant(P<0.05).Spearman correlation analysis showed that LVEF,HrEF and TEF were negatively correlated with NYHA classification in CHD patients(r=-0.518,-0.625,-0.634,P<0.001).QRSd and heart rate were positively correlated with NYHA classification(r=0.513,0.527,P<0.001).The HrEF and TEF in AF group were lower than those in non-AF group,and the differences were statistically significant(P<0.05).ROC curve analysis showed that the area under the curve(AUC) of the combined prediction of the two indexes was 0.874,which was higher than predicted by the HrEF(AUC was 0.817) and TEF alone(AUC was 0.718).Conclusion HrEF,TEF are correlated with the cardiac function classification of CHD patients,and there are high predictive value for new onset AF in CHD,which providing reference for clinical diagnosis and treatment.