心电图ST段压低、QTc、QTd及投影间夹角有助于判断慢性心力衰竭患者心脏同步化治疗的预后

陈可斌.心电图ST段压低、QTc、QTd及投影间夹角有助于判断慢性心力衰竭患者心脏同步化治疗的预后[J].内科急危重症杂志,2022,28(4):301-304

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DOI：10.11768/nkjwzzzz20220410

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作者	单位	E-mail
陈可斌	青岛市城阳区人民医院	15954255256@163.com

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中文摘要:

目的:探讨心肌复极异常心电图对慢性心力衰竭（CHF）患者心脏再同步化治疗（CRT）预后的预测价值。方法：收集102例CHF且行CRT治疗患者的临床病历资料，术后随访3年，依据随访终点情况分为死亡组25例和存活组77例。CRT术前完善所有患者心电图及心脏彩超，比较2组患者ST段压低、QTc、QTd、投影间夹角（TMD）及QRS波时限情况；采用多因素Logistic回归分析影响CHF患者CRT治疗预后的因素；绘制心电图指标对CHF患者预后的受试者工作特征（ROC）曲线，判断心电图ST段压低、QTc、QTd及TMD对CHF患者CRT治疗预后的预测价值。结果：2组的病程、纽约心脏协会（NYHA）分级、并发心房颤动、左室射血分数(LVEF)、左心室内径（LVD）及左心房内径（LAD）比较，差异有统计学意义（P均＜0.05）；死亡组病例心电图具有明显更高的ST段压低、QTc、QTd及TMD（P均<0.05）。多因素Logistic回归分析可知，NYHA分级、心房颤动、ST段压低、QTc、QTd、TMD、LVEF、LVD及LAD均是CHF患者CRT治疗预后的独立危险因素。ROC曲线显示，TMD具有最大的预测效能，其曲线下面积（AUC）为0.839，约登指数为0.61；其次为QTd，AUC为0.817，约登指数为0.44；ST段压低的AUC为0.748，约登指数为0.41；最低为QTc，AUC为0.724，约登指数为0.36。结论：心电复极参数ST段压低、QTc、QTd及TMD异常增加均提示CHF患者CRT治疗预后效果较差。

英文摘要:

Objective: evaluate the prognosis value of abnormal electrocardiogram of myocardial repolarization in patients with chronic heart failure (CHF) after cardiac resynchronization therapy (CRT). Methods: 102 CHF patients receiving CRT and completing 3 years follow-up were selected. According to the end point of follow-up, the patients were divided into death group (n=25) and survival group (n=77). The examination of electrocardiogram (ECG) and color Doppler ultrasound were done before CRT. The ST segment depression, QTc, QTd, QRS wave duration and TMD were compared between the two groups. Multivariate logistic regression analysis was used to analyze the factors influencing the prognosis of CHF patients after CRT. The receiver operating characteristic (ROC) curve of ECG indexes on the prognosis of CHF patients was drawn. Results: There were significant differences in the course of disease, NYHA grade, atrial fibrillation, LVEF, LVD and LAD between the two groups (P<0.05). The death group had significantly higher ST segment depression, QTc, QTd and TMD (P< 0.05). Multivariate logistic regression analysis showed that NYHA grade, atrial fibrillation, ST segment depression, QTc, QTd, TMD, LVEF, LVD and LAD were independent risk factors for the prognosis of CHF patients after CRT. The ROC curve showed that TMD had the highest predictive power with the area under the ROC curve (AUC) of 0.839 and Youden index of 0.61; followed by QTd with AUC of 0.817 and Youden index of 0.44; the third was ST segment depression with AUC of 0.748 and Youden index of 0.41; the lowest was QTc with AUC of 0.724 and Youden index of 0.36. Conclusion: The abnormal increases of ST segment depression, QTc, QTd and TMD suggest that the prognosis of CHF patients is poor, which can be used to predict the prognosis of CHF patients with CRT.