QRS时限变化对心脏再同步化治疗后全因死亡及心源性猝死的预测价值  

The predictive value of changes in QRS duration after cardiac resynchronization therapy in all-cause mortality and sudden cardiac death

作　　者：承燕 张常莹 李宗斌 赵晓溪 王如兴 CHENG Yan;ZHANG Changying;LI Zongbin;ZHAO Xiaoxi;WANG Ruxing(Department of Cardiology,Wuxi People's Hospital Affiliated to Nanjing Medical University,Wuxi Jiangsu 214023,China)

机构地区：[1]南京医科大学附属无锡人民医院心血管内科,江苏无锡214023

出　　处：《江苏大学学报（医学版）》2022年第5期415-421,共7页Journal of Jiangsu University：Medicine Edition

基　　金：无锡市青年医学人才项目(QNRC010)。

摘　　要：目的:探索QRS时限(QRS duration,QRSd)的变化(ΔQRSd)对心脏再同步化治疗(cardiac resynchronization therapy,CRT)后全因死亡及心源性猝死的预测价值。方法:纳入2011年3月至2020年12月南京医科大学附属无锡人民医院行CRT的患者并收集其临床资料和12导联体表心电图数据。测量术前和术后QRSd。Cox回归分析筛选全因死亡和心源性猝死的预测因子。以X-tile软件分析ΔQRSd(QRSd_(术后)-QRSd_(术前))对全因死亡和心源性猝死预测的截断值,以Kaplan-Meier生存分析判断ΔQRSd与全因死亡和心源性猝死的关系。结果:共纳入66例患者,中位随访时间72个月,15例死亡,16例发生心源性猝死事件。多因素Cox回归分析提示ΔQRSd是全因死亡的预测因子(HR=1.019,95%CI:1.004~1.035,P=0.014);ΔQRSd(HR=1.016,95%CI:1.002~1.031,P=0.024)和完全性左束支传导阻滞(HR=0.211,95%CI:0.065~0.682,P=0.009)均是心源性猝死的预测因子。ΔQRSd对全因死亡和心源性猝死预测的截断值均为0 ms。ΔQRSd>0 ms组的术前左室舒张末内径显著高于ΔQRSd≤0 ms组(P<0.001),其术前QRSd显著低于ΔQRSd≤0 ms组(P=0.001)。Kaplan-Meier生存分析提示ΔQRSd>0 ms是CRT后全因死亡、心源性猝死、5年生存率及5年心源性猝死率的预测因子(P值分别为<0.001、<0.001、0.01和<0.001)。结论:术后QRSd增宽是CRT患者全因死亡和心源性猝死的独立预测因子。Objective:To evaluate the predictive value of changes in QRS duration(ΔQRSd)after cardiac resynchronization therapy(CRT)in all-cause mortality and sudden cardiac death.Methods:Patients underwent CRT between March 2011 and December 2020 in Wuxi People′s Hospital Affiliated to Nanjing Medical University were enrolled.The clinical data including 12-lead electrocardiography were obtained.QRS durations derived from pre-and post-implantation electrocardiography were measured.Predictors for all-cause mortality and sudden cardiac death were evaluated using Cox regression analysis.X-tile software was used to analyze the cut-off ofΔQRSd for predicting all-cause mortality and sudden cardiac death.ΔQRSd was assessed in relation to all-cause mortality and sudden cardiac death by Kaplan-Meier survival analysis.Results:Sixty-six patients were enrolled with a median follow-up time of 72 months,15 died and 16 suffered from sudden cardiac death.ΔQRSd was a predictor for all-cause mortality in multiple Cox regression analysis(HR=1.019,95%CI:1.004-1.035,P=0.014).BothΔQRSd(HR=1.016,95%CI:1.002-1.031,P=0.024)and complete left bundle branch block(HR=0.211,95%CI:0.065-0.682,P=0.009)were predictors for sudden cardiac death.The cut-off ofΔQRSd for predicting all-cause mortality and sudden cardiac death was 0 ms.The pre-implantation left ventricular end-diastolic diameter in theΔQRSd>0 ms group was significantly higher than that in theΔQRSd≤0 ms group(P<0.001),and the pre-implantation QRS duration was significantly lower than that in theΔQRSd≤0 ms group(P=0.001).Kaplan-Meier survival analysis revealed thatΔQRSd>0 ms was a predictor of all-cause mortality,sudden cardiac death,5-year survival rate,and 5-year sudden cardiac death rate after CRT(P<0.001,<0.001,0.01 and<0.001,respectively).Conclusion:A post-implantation widening in QRS duration is an independent predictor of all-cause mortality and sudden cardiac death after CRT.

关 键 词：心脏再同步化治疗 QRS时限 全因死亡 心源性猝死 

分 类 号：R541.6[医药卫生—心血管疾病]