| 任晓敏,于万德,胡作英,顾 凯,潘 昌.心电图QRS波时限、左室射血分数与老年心力衰竭患者心功能的关系及对心功能恶化的预测价值研究[J].,2024,(6):1095-1099 |
| 心电图QRS波时限、左室射血分数与老年心力衰竭患者心功能的关系及对心功能恶化的预测价值研究 |
| The Relationship between QRS Duration, Left Ventricular Ejection Fraction and Cardiac Function in Elderly Patients with Heart Failure and Its Predictive Value for Cardiac Function Deterioration |
| 投稿时间：2023-09-12 修订日期：2023-10-10 |
| DOI：10.13241/j.cnki.pmb.2024.06.017 |
| 中文关键词: QRS波时限 左室射血分数 心力衰竭 |
| 英文关键词: QRS duration Left ventricular ejection fraction Heart failure |
| 基金项目:国家自然科学基金项目（82100438） |
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| 中文摘要: |
| 摘要 目的：探讨心电图QRS波时限（QTcd）、左室射血分数（LVEF）与老年心力衰竭患者心功能的关系及对心功能恶化的预测价值。方法：选取我院2018年1月到2022年1月收治的150例老年心力衰竭患者作为研究对象，将所有患者应用NYHA分级进行分组，Ⅰ级26例，Ⅱ级37例，Ⅲ级例54，Ⅳ级33例。对所有患者进行心电图与心脏超声诊断，对比四组患者QRSd、LVEF水平，并应用Spearman相关分析法分析QRSd、LVEF与老年心力衰竭患者心功能的相关性。随后对所有患者在出院后维持12个月的随访，将发生急性心肌梗死、死亡的终点事件患者和NYHA分级与治疗前相比升高＞1级的患者分为心功能恶化组（n=50），将其余患者分为非心功能恶化组（n=100），对比两个亚组患者临床一般情况及QRSd、LVEF表达，并应用logistic回归分析分析QRSd、LVEF对老年心力衰竭患者心功能恶化的预测价值。结果：不同心功能分级老年心力衰竭患者QRSd、LVEF表达对比差异显著，Ⅳ级患者QRSd水平高于Ⅲ级、Ⅱ级和Ⅰ级患者，Ⅳ级患者LVEF水平低于Ⅲ级、Ⅱ级和Ⅰ级患者（P＜0.05）；Spearman相关分析结果显示：QRSd与心功能程度呈正相关（P＜0.05），而LVEF与HBV心功能程度呈负相关（P＜0.05）；心功能恶化组与非心功能恶化组患者性别、年龄、体质量指数（BMI）、合并糖尿病、高血压、左心室舒张末期内径（lLVEDD）对比无明显差异（P＞0.05），心功能恶化组与非心功能恶化组患者NYHA分级、合并陈旧性心肌梗死、合并高血脂、QT间期（QRSd）、QTcd、氨基末端 A 型利钠肽（NT-proANP）、C反应蛋白（CPP）、左心室质量指数（LVMI）、LVEF水平对比差异显著（P＜0.05）；logistic回归分析结果表明：NYHA分级、合并陈旧性心肌梗死、QRSd、QTcd、NT-proANP、CPP、LVMI、LVEF均为老年心力衰竭患者心功能恶化的独立预测指标（P＜0.05）。结论：QRSd、LVEF与老年心力衰竭患者心功能具有明显相关性，且临床可以考虑对QRSd升高、LVEF降低可能预示患者心功能恶化，因此临床可以考虑对QRSd升高、LVEF降低的老年心力衰竭患者及时调整治疗方案，预防心功能恶化的发生。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the relationship between QRS duration (QTcd), left ventricular ejection fraction (LVEF) and cardiac function in elderly patients with heart failure and its predictive value for the deterioration of cardiac function. Methods: 150 elderly patients with heart failure treated in our hospital from January 2018 to January 2022 were selected as the research object, and all patients were grouped by NYHA classification, including 26 cases of grade I, 37 cases of grade II, 54 cases of grade III and 33 cases of grade IV. All patients were diagnosed by ECG and echocardiography. The levels of qrsd and LVEF in the four groups were compared, and the correlation between qrsd, LVEF and cardiac function in elderly patients with heart failure was analyzed by Spearman correlation analysis. All patients were followed up for 12 months after discharge. Patients with acute myocardial infarction and death and patients with NYHA grade higher than 1 compared with that before treatment were divided into cardiac function deterioration group (n=50), and the remaining patients were divided into non cardiac function deterioration group (n=100). The clinical general conditions and the expression of qrsd and LVEF in the two subgroups were compared, and the logistic regression analysis was used to analyze the expression of qrsd, LVEF The predictive value of LVEF on the deterioration of cardiac function in elderly patients with heart failure. Results: There were differences in the expression of qrsd and LVEF in elderly patients with heart failure of different functional grades. The level of qrsd in patients with grade Ⅳ was higher than that in patients with grade Ⅲ, Ⅱ and Ⅰ, and the level of LVEF in patients with grade Ⅳ was lower than that in patients with grade Ⅲ, Ⅱ and Ⅰ(P<0.05); Spearman correlation analysis showed that qrsd was positively correlated with the degree of cardiac function (P<0.05), while LVEF was negatively correlated with the degree of HBV cardiac function (P<0.05); There were no differences in gender, age, body mass index (BMI), diabetes mellitus, hypertension, left ventricular end diastolic dimension (LVEDd) between the deterioration group and the non deterioration group (P>0.05) The levels of QT interval (qrsd), QTcd, amino terminal A-type natriuretic peptide (NT proANP), C-reactive protein (CPP), left ventricular mass index (LVMI) and LVEF were different (P<0.05); Logistic regression analysis showed that NYHA classification, combined with old myocardial infarction, qrsd, QTcd, NT proANP, CPP, LVMI and LVEF were independent predictors of cardiac function deterioration in elderly patients with heart failure(P<0.05). Conclusion: Qrsd and LVEF are significantly correlated with cardiac function in elderly patients with heart failure, and the increase of qrsd and the decrease of LVEF may predict the deterioration of cardiac function in patients with heart failure, so the treatment scheme for elderly patients with heart failure with increased qrsd and decreased LVEF can be adjusted in time to prevent the deterioration of cardiac function. |
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