Relationship Between fQRS Complex and Clinical Response and Prognostic Value Before Double Chamber Pacemaker Pacemaker Implantation in Elderly Patients with Chronic Heart Failure
Objective To explore and analyze the relationship between fragmented QRS complex(fQRS)complex and clinical response and prognosis before implant of pacemaker in elderly patients with chronic heart failure.Methods A total of 136 elderly patients with chronic heart failure admitted to the First Outpatient Department of Henan Province from January 2016 to December 2019 were selected as the research objects.According to whether the patients had fQRS before implant of pacemaker,they were divided into fQRS group(34 cases)and non-fQRS group(102 cases).The clinical response of the two groups of patients at 6 months after pacemaker implantation was compared,and the New York Heart Association(NYHA)cardiac function classification and 6-minute walking test(6MWT),Minnesota heart failure quality of life scale(MLHFQ)scores,left ventricular ejection fraction(LVEF)and left ventricular end systolic volume(LVESV)change value were compared between the two groups before and 6 months after the operation.Both groups of patients were followed up for 3 years,and the rates of all-cause death and heart failure re-hospitalization were compared between the two groups.Cox regression was used to analyze the independent factors influencing the occurrence of all-cause deaths after treatment.Results There were no significant differences between the two groups of patients in gender,age,previous disease history(coronary heart disease,atrial fibrillation,and left bundle branch block),and NYHA cardiac function classification at admission(P＞0.05),but the LVEF level of in the fQRS group was lower than that of the non-fQRS group,and the level of N-terminal pro-brain natriuretic peptide(NT-proBNP)was higher than that of the non-fQRS group(P＜0.001).After 6 months of follow-up,only 18 patients(52.94％)in the fQRS group had clinical responses,and 93(91.18％)patients in the non-fQRS group had clinical responses(P＜0.001).At 6 months after surgery,the 6MWT,NYHA cardiac function classification,MLHFQ,LVESV and LVEF changes in the fQRS group were lower than those in the non-fQRS group,and the differences were statistically significant(P＜0.001).After 3 years of follow-up,the rates of all-cause mortality and re-hospitalization due to heart failure in the fQRS group were higher than those in the non-fQRS group,and the difference was statistically significant(P＜0.001).Cox regression analysis showed that the preoperative fQRS(HR=2.328,95％CI 1.303-4.159)and the preoperative NT-proBNP level(HR=2.683,95％CI 1.441-4.994)all were the independent risk factors affecting all-cause death of CHF patients.Conclusion The appearance of fQRS complex before pacemaker implantation in elderly patients with chronic heart failure can reduce the clinical response rate of pacemaker implantation,and is an independent risk factor affecting all-cause death in patients with chronic heart failure.Clinical attention should be paid to and early intervention should be given to improve the clinical treatment effect of pacemaker implantation.
万方数据
维普
