心电图异常对预测扩张型心肌病致慢性心力衰竭患者的预后意义  

Predictive Value of Electrocardiogram Abnormality on Prognosis of Chronic Heart Failure in Patients With Dilated Cardiomyopathy

作　　者：杨洁[1] 侯翠红[1] 刘周英[1] 任岚[1] 孙兴国[1] 浦介麟[1] 

机构地区：[1]北京协和医学院中国医学科学院国家心血管病中心阜外医院功能检测中心,北京市100037

出　　处：《中国循环杂志》2016年第3期218-222,共5页Chinese Circulation Journal

基　　金：国家973项目(编号:2013CB531105)

摘　　要：目的：评价12导联心电图对扩张型心肌病致慢性心力衰竭（心衰）患者预后的预测作用。方法：前瞻性、多中心随访787例扩张型心肌病致慢性心衰患者。通过门诊随诊或电话、信件随访慢性心衰患者的终点事件。用Cox风险比例回归分析确定全因死亡的独立预测因子,对QRS时限是否大于120 ms等心电图指标用Kaplan-Meier曲线进行生存分析（log-rank检验）。结果：随访过程中203例死亡。经Cox回归分析发现心房颤动与全因死亡有关[风险比（HR）=2.064;95%可信区间（CI）：1.102~3.864,P〈0.05];非持续性室性心动过速与全因死亡有关[HR=3.887;95%CI：1.554~9.724,P〈0.05];QRS时限与全因死亡有关[HR=1.010;95%CI：1.002~1.018,P〈0.05]。Kaplan-Meier生存曲线分析显示,以QRS时限分层,不同水平的QRS时限其生存率之间的差异具有统计学意义（P〈0.05）。结论：对扩张型心肌病致慢性心衰患者生存率有影响的心电图指标是心房颤动、非持续性室性心动过速和QRS时限;不同水平QRS时限与生存率之间存在显著差异。Objective： To study the predictive value of 12-lead electrocardiogram（ECG） abnormality on prognosis of chronic heart failure in patients with dilated cardiomyopathy（DCM-CHF）.Methods： A prospective, multicenter follow-up study in 787 DCM-CHF patients was conducted, and the endpoints were obtained by clinical visit, mail contact and telephone conversation. The independent predictors for all cause death were determined by Cox regression analysis, QRS duration 120 ms was studied and the survival rates were investigated by KaplanMeier analysis.Results： There were 203 patients died during the follow-up period. Cox regression analysis found that the following indexes were related to all cause death： atrial fibrillation（AF）（HR=2.064, 95% CI 1.102-3.864, P〈0.05）, non-sustained ventricular tachycardia（NSVT）（HR=3.887, 95% CI 1.554-9.724, P0.05） and QRS duration（HR=1.010, 95% CI 1.002-1.018, P0.05）. Kaplan-Meier analysis revealed that the survival rates were different by each stratification of QRS duration, P0.05.Conclusion： ECG indexes of AF, NSVT and QRS duration had the important impact on the survival rate in DCM-CHF patients; there were significant differences between QRS durations and survival rates.

关 键 词：心肌病 扩张型 心力衰竭 心电描记术 预测 

分 类 号：R54[医药卫生—心血管疾病]