心电图QRS波时限延长对老年高血压合并心力衰竭患者心脏不良事件的预测价值  

Predictive value of prolonged QRS wave duration on adverse cardiac events in elderly patients with hypertension and heart failure

作　　者：周蓉 张懿 Zhou Rong;Zhang Yi(Department of Special Inspection,the Third Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine,Hangzhou,Zhejiang 310007,China;Electrocardiogram Room,Zhejiang Xinhua Hospital,Hangzhou,Zhejiang 310000,China)

机构地区：[1]浙江中医药大学附属第三医院特检科,杭州310007 [2]浙江省新华医院心电图室,杭州310000

出　　处：《中国基层医药》2020年第15期1818-1822,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨心电图QRS波时限延长对老年高血压合并心力衰竭患者心脏不良事件(MACE)的预测价值。方法选取2015年4月至2018年5月浙江中医药大学附属第三医院及浙江省新华医院收治的老年高血压合并心力衰竭患者226例,患者入院后即刻进行18导联心电图检查,根据QRS波时限进行分组,分为QRS波时限≤120 ms组157例、QRS波时限>120 ms组69例。比较两组患者心功能相关指标、血清N末端脑钠肽前体(NT-proBNP)水平及出院6个月MACE发生率;比较MACE发生患者与未发生MACE患者入院QRS波时限,并采用ROC曲线分析QRS波时限对患者MACE的预测价值。结果QRS波时限>120 ms组患者左室射血分数(LVEF)(37.49±4.03)%,明显低于QRS波时限≤120 ms组的(44.37±4.92)%(t=10.205,P<0.05);QRS波时限>120 ms组患者左室舒张末期内径(LVEDD)(59.03±3.15)mm、左心室质量指数(LVMI)(147.38±16.28)g/m2、血清NT-proBNP(1097.59±216.49)ng/L,均显著高于QRS波时限≤120 ms组的(56.39±3.97)mm、(138.96±15.36)g/m2及(825.36±185.36)ng/L(t=4.887、3.726、9.649,均P<0.05)。QRS波时限>120 ms组MACE发生率为53.62%(37/69),明显高于QRS波时限≤120 ms组的20.38%(32/157)(χ^2=24.973,P<0.05)。QRS波时限与LVEF呈显著负相关关系(r=-0.316,P<0.05),与LVEDD、LVMI及血清NT-proBNP均呈显著正相关关系(r=0.362、0.405、0.378,均P<0.05)。发生MACE患者入院QRS波时限为(137.64±21.05)ms,明显长于无MACE患者的(112.65±19.85)ms(t=8.556,P<0.05)。采用ROC曲线分析QRS波时限对MACE预测价值,曲线下面积为0.852。结论QRS波时限与老年高血压合并心力衰竭患者心功能及血清NT-proBNP水平密切相关,QRS波时限延长对患者MACE发生具有良好的预测价值,可作为临床监测指标。Objective To investigate the predictive value of prolonged QRS duration of electrocardiogram for adverse cardiac events in elderly patients with hypertension and heart failure.Methods From April 2015 to May 2018,226 elderly patients with hypertension complicated with heart failure were selected in the Third Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine.After admission,18 leads ECG were examined immediately.According to the time limit of QRS wave,the patients were divided into 157 cases of QRS wave≤120 ms group and 69 cases of QRS wave>120 ms group.The related indicators of cardiac function,serum N-terminal brain natriuretic peptide precursor(NT-proBNP)and the incidence of major adverse cardiovascular events(MACE)at 6 months after discharge were compared between the two groups.The time limit of QRS wave in patients with MACE and those without MACE was compared,and the predictive value of QRS wave time limit in patients with MACE was analyzed by ROC curve.Results The LVEF[(37.49±4.03)%]of the patients with QRS wave duration>120 ms was significantly lower than that of the patients with QRS wave duration<120 ms[(44.37±4.92)%](t=10.205,P<0.05).The LVEDD[(59.03±3.15)mm],LVMI[(147.38±16.28)g/m2]and serum NT-proBNP[(1097.59±216.49)ng/L]in the patients with QRS wave duration>120 ms were significantly higher than those in the patients with QRS wave duration<120 ms[(56.39±3.97)mm,(138.96±15.36)g/m2 and(825.36±185.36)ng/L](t=4.887,3.726,9.649,all P<0.05).The incidence of MACE in the patients with QRS duration>120 ms(53.62%)was significantly higher than that in the patients with QRS duration<120 ms(20.38%)(χ^2=24.973,P<0.05).The QRS wave duration was negatively correlated with LVEF(r=-0.316,P<0.05),and positively correlated with LVEDD,LVMI and serum NT-proBNP(r=0.362,0.405,0.378,P<0.05).The time limit of QRS wave in the patients with MACE[(137.64±21.05)ms]was significantly longer than that in the patients without MACE[(112.65±19.85)ms](t=8.556,P<0.05).The predictive value of QRS wave

关 键 词：心电描记术 QRS波时限延长 高血压 心力衰竭 心脏不良事件 每搏输出量 左室舒张末期内径 左心室质量指数 N末端脑钠肽前体 老年人 

分 类 号：R541.6[医药卫生—心血管疾病] R544.1[医药卫生—内科学]