摘要
目的 研究心电图定量参数与射血分数降低型心力衰竭(HFrEF)心功能相关性及对并发主要心血管不良事件(MACE)预警作用.方法 选取2021年9月～2023年6月青岛市胶州中心医院收治105例有完整随访数据的HFrEF患者作为研究对象,根据12个月内是否发生MACE分为MACE组和无MACE组,入院后均行心电图监测,比较两组临床资料及心电图定量参数[T波峰末间期(Tp-Te)、Tp-Te/√RR、校正Q-T间期离散度(QTcd)、QRS波时程(QRsd)],分析心电图定量参数与左心室射血分数(LVEF)相关性,并分析HFrEF患者并发MACE的相关影响因素及心电图定量参数对HFrEF患者并发MACE的预测价值.结果 MACE组纽约心脏病协会(NYHA)心功能分级高于无MACE组,LVEF低于无MACE组(P<0.05);MACE组Tp-Te、Tp-Te/√RR、QTcd、QRSd均高于无MACE组[(115.00±16.84)ms比(99.52±13.47)ms、(4.18±0.75)比(3.79±0.66)、(110.45±12.76)ms比(95.38±18.45)ms、(139.67±10.51)ms比(117.34±12.49)ms,P<0.05];Tp-Te、Tp-Te/√RR、QTcd、QRSd与LVEF呈负相关(r=-0.787、-0.713、-0.754、-0.770,P<0.05);Tp-Te、Tp-Te/√RR、QTcd、QRSd是HFrEF患者并发MACE的独立相关危险因素(P<0.05);Tp-Te、Tp-Te/√RR、QTcd、QRSd中QTcd预测HFrEF患者并发MACE的AUC最大,Tp-Te预测HFrEF患者并发MACE的特异度最大,QTcd和Tp-Te联合预测HFrEF患者并发MACE的AUC为0.925,大于QTcd,敏感度为85.71%,特异度为82.86%(P<0.05).结论 心电图定量参数与HFrEF患者心功能密切相关,为临床早期预测MACE发生提供参考依据,以针对性制定干预方案,降低MACE发生风险.
Abstract
Objective To investigate the correlation between quantitative ECG parameters and cardiac function in patients with reduced ejection fraction heart failure(HFrEF)and the early warning role for the major adverse cardiac events(MACE).Methods A total of 105 HFrEF patients with complete follow-up data admitted to Qingdao Jiaozhou Central Hospital from September 2021 to June 2023 were selected as the study objects.According to whether MACE occurred within 12 months,the patients were divided into the MACE group and non-MACE group.Ecg monitoring was performed after admission.The clinical data and quantitative parameters of electrocardiogram[T peak interval(Tp-Te),Tp-Te/√RR,corrected Q-T interval dispersion(QTcd),QRS wave history(QRsd)]of the two groups were compared,and the correlation between quantitative parameters of electrocardiogram and left ventricular ejection fraction(LVEF)was analyzed.The related influencing factors of MACE in HFrEF patients and the predictive value of quantitative ECG parameters for MACE in HFrEF patients were analyzed.Results Compared with the no MACE group,the NYHA cardiac function grade was higher but LVEF was lower in the MACE group(P<0.05).Tp-Te,Tp-Te/√RR,QTcd and QRSd in MACE group were higher than those in non-MACE group[(115.00±16.84)ms vs.(99.52±13.47)ms,(4.18±0.75)vs.(3.79±0.66),(110.45±12.76)ms vs.(95.38±18.45)ms,(139.67±10.51)ms vs.(117.34±12.49)ms,P<0.05].Tp-Te,Tp-Te/√RR,QTcd,QRSd were negatively correlated with LVEF(r=-0.787,-0.713,-0.754,-0.770,P<0.05).Multivariate logistic regression analysis showed that Tp-Te,Tp-Te/√RR,QTcd and QRSd were the independent risk factors for MACE in HFrEF patients(P<0.05).Among the Tp-Te,Tp-Te/√RR,QTcd and QRSd,QTcd had the largest AUC in predicting MACE in HFrEF patients,and Tp-Te had the largest specificity in predicting MACE in HFrEF patients.The AUC of MACE in HFrEF patients predicted by the combination of QTcd and Tp-Te was 0.925,which was larger than that of QTcd alone,of which the sensitivity was 85.71%and the specificity was 82.86%(P<0.05).Conclusion The quantitative parameters of ECG are closely related to the cardiac function of HFrEF patients,which would provide a reference for early clinical prediction of MACE so as to make the targeted intervention plans and reduce the risk of MACE.
基金项目
青岛市医药卫生科研指导项目(2023-WJZD141)
NETL
NSTL
万方数据