摘要
目的探讨QRS波时限对慢性左心衰竭患者短期预后的影响。方法选取2014年1月至2015年6月北京大学第一医院纽约心功能分级（NYHA）Ⅲ～Ⅳ级的慢性左心衰竭住院患者174例,据QRS波时限分为QRS波时限正常组（145例,QRS波时限≤120 ms）、QRS波时限延长组（29例,QRS波时限〉120 ms）,比较两组患者一般临床特征及住院期间左心衰竭急性加重、致命性心律失常和心原性死亡发生情况的差异。采用logistic回归模型分析慢性左心衰竭患者住院期间发生不良心血管事件的影响因素。结果 QRS波时限延长组的男性占比（75.9%比43.4%,P=0.001）、B型脑钠肽的自然对数（ln BNP）（7.1±0.8比6.6±1.0,P=0.020）、左心室舒张末期内径（LVEDd）[（60.7±9.9）mm比（53.5±10.8）mm,P=0.001]及左心室收缩末期内径（LVESd）[（49.1±13.3）mm比（39.7±13.0）mm,P〈0.001],住院期间左心衰竭急性加重（20.7%比4.8%,P=0.003）、致命性心律失常（55.2%比21.4%,P〈0.001）和心原性死亡（6.9%比0.7%,P=0.019）发生率均较QRS波时限正常组高;左心室射血分数（LVEF）较QRS波时限正常组低[（39.6±17.3）%比（50.5±17.3）%,P=0.002]。按性别分层后,男性QRS波时限延长组的心率[（92.4±21.4）次/min比（81.6±19.9）次/min,P=0.035]、ln BNP（7.2±0.8比6.7±1.0,P=0.029）、LVEDd[（63.5±9.1）mm比（57.9±9.1）mm,P=0.015]、LVESd[（52.9±12.2）mm比（44.3±11.8）mm,P=0.005],住院期间左心衰竭急性加重（18.2%比3.2%,P=0.018）、致命性心律失常（63.6%比36.5%,P=0.027）和心原性死亡（9.1%比0,P=0.015）发生率均较QRS波时限正常组高;LVEF较QRS波时限正常组低[（35.0±15.3）%比（47.1±16.2）%,P=0.003]。女性QRS波时限延长组住院期间的左心衰竭急性加重发生率较QRS波时限正常组高（28.6%比6.1%,P=0.034）。相关性分析显示,QRS波时限与LVEDd（r=0.4019,P〈0.001）和LVESd（r=0.3289,P〈0.001）均呈正相关。男性组LVEF较�
Objective To study the effects of QRS-complex duration of patients with chronic left heart failure on their in-hospital prognosis. Methods Total 174 patients admitted for chronic left heart failure（ New York Heart Association class 3 and 4） from January 2014 to June 2015 were enrolled the study. They were divided into two groups according to the QRS duration at admission： normal QRS duration group（ QRS ≤120 ms,n = 145） and prolonged QRS group（ QRS 120 ms,n = 29）. The differences of clinical characteristics and incidences of exacerbated left heart failure,fatal arrhythmias and cardiac death during hospitalization were compared between the two groups. The influences of QRS duration on in-hospital adverse cardiovascular events was analyzed by logistic regression. Results The proportion of males（ 75. 9% vs. 24. 1%,P = 0. 001）,plasma B-type natriuretic peptide（ BNP）（ 7. 1 ± 0. 8 vs. 6. 6 ± 1. 0,P= 0. 02）,left ventricular end diastolic diameter（ LVEDd） [（ 60. 7 ± 9. 9） mm vs.（ 53. 5 ± 10. 8） mm,P =0. 001],left ventricular end systolic diameter（ LVESd） [（ 49. 1 ± 13. 3） mm vs.（ 39. 7 ± 13. 0） mm,P〈 0. 001],and the incidence of exacerbated left heart failure（ 20. 7% vs. 4. 8%,P = 0. 003）,fatal arrhythmias（ 55. 2% vs. 21. 4%,P〈 0. 001） and cardiac death（ 6. 9% vs. 0. 7%,P = 0. 019） during hospitalization were significantly higher in the prolonged QRS group than in the normal QRS group. Left ventricular ejection fraction（ LVEF） in the prolonged QRS group was significantly lower than in the normal QRS group（ 39. 6% ± 17. 3% vs. 50. 5% ± 17. 3%,P = 0. 002）. Heart rates [（ 92. 4 ± 21. 4） bpm vs.（ 81. 6 ± 19. 9） bpm,P = 0. 035],plasma BNP（ 7. 2 ± 0. 8 vs. 6. 7 ± 1. 0,P = 0. 029）,LVEDd（ 63. 5 ± 9. 1vs. 57. 9 ± 9. 1,P = 0. 015）,LVESd（ 52. 9 ± 12. 2 vs. 44. 3 ± 11. 8,P = 0. 005）,incidences of left heart failure deterioration（ 18. 2% vs. 3. 2%,P = 0. 018）,fatal arrhythmias（ 63. 6% vs. 36. 5%,P = 0. 027）and cardia
出处
《中国介入心脏病学杂志》
2016年第3期154-159,共6页
Chinese Journal of Interventional Cardiology
关键词
心电图
QRS波时限
慢性左心衰竭
预后
危险因素
Electrocardiography
QRS complex duration
Chronic left heart failure
Prognosis
Risk factors
