摘要
目的探讨老年慢性心力衰竭(CHF)患者心电图平面QRS-T夹角预测再入院和全因死亡的临床价值。方法以2014年3月至2016年3月住院的老年CHF患者为研究对象,按心电图平面QRS-T夹角分为夹角≤90°组和夹角>90°组,分析比较临床资料,并在出院后随访12个月。结果共纳入224例,夹角≤90°组168例,夹角>90°组56例。与夹角≤90°组比较,夹角>90°组年龄、NYHA心功能分级、左心室舒张末期内径(LVEDD)、B型脑钠肽(BNP)、C反应蛋白(CRP)、尿酸(UA)水平较高,而左心室射血分数(LVEF)偏低,差异均有统计学意义(均P<0.05)。心力衰竭再入院和全因死亡比例夹角>90°组显著高于≤90°组(64.3%vs 25.0%,χ2=28.561,P<0.01)。Spearman相关性分析显示QRS-T夹角与NYHA心功能分级呈正相关(rs=0.256,P<0.01)。Cox模型显示QRS-T夹角>90°是老年CHF患者再入院和全因死亡的独立危险因素(HR=1.674,95%CI:1.420～3.064,P<0.05);ROC曲线显示QRS-T夹角预测心力衰竭再入院和全因死亡的ROC曲线AUC为0.785,最佳诊断截点(cut-off)为112°,灵敏度80.7%,特异度61.9%。结论老年CHF患者心电图平面QRS-T夹角增大者心功能较差,心力衰竭再入院和全因死亡增加。
Objective To investigate the clinical value of plane QRS-T angle in electrocardiogram for predictingre-hospitalization and death in elderly patients with chronic heart failure （CHF） . Methods The elderly inpatients withCHF during March 2014 and March 2016 were studied prospectively. They were divided into QRS-T angle ≤90° groupand QRS-T angle〉90°group based on plane QRS-T angle in electrocardiogram. Clinical data were analyzed andcompared between the two groups. All patients received 12 months follow-up after discharge. Results A total of 224patients were enrolled. Of them,168 cases were in QRS-T angle ≤90° group and 56 in QRS-T angle〉90°group.NYHA classification,left ventricular end-diastolic diameter,B-type brain natriuretic peptide,C-reactive protein and uricacid level were significantly higher,and left ventricular ejection fraction was significantly lower in of QRS-T angle〉90°group than ≤90° group （P〈0.05 for all） . The ratio of readmission and all-cause death was significantly higher in QRS-Tangle〉90° group than ≤90° group （64.3% vs 25.0%, 字2=28.561,P=0.000） . Spearman correlation analysis showed thatQRS-T angle was positively correlated with NYHA classification（rs=0.256,P=0.000） . COX proportional hazards modelshows QRS-T angle〉90° was an independent risk factor for readmission and all-cause death in elderly patients withCHF（HR=1.674,95%CI：1.420~3.064,P=0.012） . Receiver-operating characteristic curve（ROC）shows that the areaunder curve（AUC）of QRS-T angle predicting readmission and all-cause death was 0.785,the best diagnostic cut-offpoint （cut-off）was 112° with sensitivity and specificity 80.7% and 61.9%,respectively. Conclusion Elderly CHFpatients with increase of plane QRS-T angle in electrocardiogram have worse cardiac function,high re-hospitalization rate and all-cause mortality.
作者
许兰芳
邬小花
丁秋燕
XU Lanfang;WU Xiaohua;DING Qiuyan(Electrocardiogram Room,Zhoushan Hospital,Zhoushan 316000,China)
出处
《心电与循环》
2018年第5期320-324,共5页
Journal of Electrocardiology and Circulation
关键词
QRS-T夹角
心电图
心力衰竭
再住院
全因死亡
QRS-T angle
Electrocardiography
Heart failure
Rehospitalization
All-cause death
