【摘要】：目的:心力衰竭是各種心血管疾病嚴(yán)重和終末階段,心臟結(jié)構(gòu)和(或)功能發(fā)生改變,伴心室復(fù)極異常,可發(fā)生惡性心律失常甚至猝死。心室復(fù)極異常的主要心電圖表現(xiàn)為QT間期延長及T波形態(tài)改變。研究表明心電圖T波形態(tài)學(xué)參數(shù)是預(yù)后不良的預(yù)測指標(biāo)。方法:收集單中心資料,按一定的納入及排除標(biāo)準(zhǔn)選定心衰組及非心衰組患者。收集臨床資料,T波形態(tài)學(xué)參數(shù)由計(jì)算機(jī)軟件自動(dòng)計(jì)算,為12導(dǎo)聯(lián)參數(shù)的平均值,包括QRS-T夾角、QT間期離散度和QTp間期離散度、T波峰末間期、T波主要成分比值、扁平性評(píng)分、不對(duì)稱性評(píng)分、切跡性評(píng)分、形態(tài)綜合評(píng)分。對(duì)心衰組采取電話隨訪,終點(diǎn)事件為死亡,其中心因死亡包括泵衰竭、急性心肌梗死、惡性心律失常。非心衰組未實(shí)行隨訪。先進(jìn)行心衰組與非心衰組基線資料及T波形態(tài)學(xué)參數(shù)比較;后對(duì)心衰患者的心因死亡組與存活組基線資料、T波形態(tài)學(xué)參數(shù)進(jìn)行比較;心因性死亡的生存時(shí)間分析及其影響因素COX回歸分析;最后對(duì)獨(dú)立危險(xiǎn)因素作為判斷標(biāo)準(zhǔn)的價(jià)值分析。結(jié)果:納入心衰患者219人,對(duì)照組210人,兩組年齡、性別無差異(P0.05),除QTp間期離散度外,其他T波形態(tài)學(xué)參數(shù)均有差異;心衰組QRS-T夾角、T波峰末間期、QT間期離散度、T波主要成分比值、形態(tài)綜合評(píng)分、扁平性評(píng)分高于對(duì)照組,心衰組T波不對(duì)稱性評(píng)分低于對(duì)照組。心衰組患者平均隨訪17.50±7.40個(gè)月,全因死亡16人,其中心因性死亡11人,生存203人,心因死亡率5.02%。對(duì)比心因死亡及存活組的基線資料(除高血壓外)均無差異(P0.05),對(duì)比T波形態(tài)學(xué)參數(shù),QRS-T夾角死亡組高于存活組(142(126-161)vs 87(47-120),P=0.002),T波形態(tài)綜合評(píng)分死亡組低于存活組(76(71-88)vs 84(72-101),P=0.047),T波不對(duì)稱性評(píng)分死亡組低于存活組(7(3-10)vs 8(4-16),P=0.048),其它無差異。隨訪期內(nèi)平均生存時(shí)間為33.35個(gè)月,95%置信區(qū)間為(32.06-33.72)個(gè)月,累計(jì)生存率1年為99.5%,2年為97.7%,QRS-T夾角≥90°者1年后生存率較90°者明顯下降(P=0.002)。采用乘積極限法行COX回歸分析,單因素分析提示合并房顫、房撲的患者平均生存時(shí)間短于不合并者(31.112±0.546 VS 33.937±0.370,P=0.039),QRS夾角≥90°者平均生存時(shí)間短于90°者(33.18±0.14 VS 32.35±0.68,P=0.002),其它基線資料以及其它T波形態(tài)學(xué)參數(shù)無差異(P均0.05),其中QTp間期離散度的P=0.083,為臨界值。將P0.05或?yàn)榕R界值的參數(shù)及性別、年齡、左室射血分?jǐn)?shù)納入多因素分析,提示QRS-T夾角仍是影響預(yù)后的因素,P=0.020,QRS夾角增大(≥90°)的相對(duì)危險(xiǎn)度RR為12.113。若將QRS-T夾角作為判斷心衰患者發(fā)生心因死亡的預(yù)測標(biāo)準(zhǔn),ROC曲線下面積分別為0.733(0.50),P值為0.002(0.05)、95%可信區(qū)間為0.619-0.926,說明QRS-T夾角作為判斷心衰預(yù)后的指標(biāo)是有意義的。結(jié)論:心衰患者T波形態(tài)學(xué)參數(shù)較非心衰者存在顯著改變。QRS-T夾角是心衰患者發(fā)生心因性死亡的獨(dú)立危險(xiǎn)因素,QRS-T夾角≥90°作為判斷預(yù)后的標(biāo)準(zhǔn)是有效的。
[Abstract]:Objective: heart failure is a serious and terminal stage of various cardiovascular diseases, cardiac structure and / or function changes, accompanied by abnormal ventricular repolarization, malignant arrhythmia or even sudden death. The main electrocardiographic manifestations of ventricular repolarization abnormalities were the prolongation of QT interval and the changes of T wave morphology. The study showed that T wave morphological parameters were predictors of poor prognosis. Methods: single-center data were collected to select patients with heart failure and non-heart failure according to certain inclusion and exclusion criteria. The morphological parameters of T wave were calculated automatically by computer software, which was the average value of 12 lead parameters, including QRS-T angle, QT interval dispersion and QTp interval dispersion, the ratio of main components of T wave at the end of T wave peak and the flat score. Asymmetry score, notch score, morphological comprehensive score. The heart failure group was followed up by telephone. The terminal event was death. The central death included pump failure, acute myocardial infarction, and malignant arrhythmia. No follow-up was performed in the non-heart failure group. Baseline data and T wave morphological parameters of heart failure group and non-heart failure group were compared firstly, and then T wave morphological parameters of heart failure group and survival group were compared. The survival time of psychogenic death and its influencing factors were analyzed by COX regression analysis. Finally, the value analysis of independent risk factors as the criterion was analyzed. Results: there was no difference in age and sex between the two groups (P 0.05). The morphological parameters of T wave were all different except QTp interval dispersion. In the heart failure group, the ratio of the main components, the morphological comprehensive score and the flat score were higher than those in the control group, and the T wave asymmetry score in the heart failure group was lower than that in the control group. The patients in the heart failure group were followed up for an average of 17.50 鹵7.40 months. All the 16 patients died because of heart failure, of which 11 died because of the heart, 203 survived, and 5.02 died of the heart failure. There was no difference in baseline data (except hypertension) in cardiac death and survival group (P0.05). The morphological parameters of T wave and QRS-T angle in death group were higher than those in survival group (142 (126-161) vs 87 (47-120) P0. 002). The comprehensive score of T wave morphology in death group was lower than that in survival group (76 (71-88) vs 84 (72-101) P0. 047). The sex score in the death group was lower than that in the survival group (7 (3-10) vs 8 (4-16) P 0. 048). The mean survival time was 33.35 months, 95% confidence interval was (32.06-33.72) months, the cumulative survival rate was 99.5 months, and the survival rate was significantly lower in those with 97.7 QRS-T angle 鈮，

本文編號(hào)：2153018