Prognostic value of planar QRS-T angle in patients with poor outcomes of acute heart failure syndrome
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摘要: 目的:通过分析平面QRS-T夹角与急性心力衰竭综合征(acute heart failure syndromes,AHFS)近、远期不良结局相关性评价其预后预测价值。方法:2所中心医院125例AHFS患者,根据入院首次心电图平面QRS-T夹角将患者分为<90°组和≥90°组。采集患者入院首次病史、体征、辅助检查等基线变量,比较两组患者基线参数差异。随访入院至出院后30d(近期)和1年(远期)不良结局发生情况,Kaplan-Meier(K-M)生存分析进行2组近、远期不良预后发生率差异比较,Cox回归模型多因素分析平面QRS-T夹角≥90°与不良预后关系。结果:所有患者平均平面QRS-T夹角为(116.5±46.9)°。≥90°组96例患者中远期不良结局92例,其中50例为近期不良结局患者。<90°组29例患者中远期不良结局19例,其中8例为近期不良结局患者。与<90°组患者相比,≥90°组心影增大、V1导联终末电势(PtfV1)≤-0.04 mm·s更多见,并且有更低的肾小球滤过率估计值(eGFR)和左室射血分数(LVEF)、更高的CK-MB和肌钙蛋白I。K-M曲线:两组近、远期不良结局发生率曲线差别均有统计学意义。经PtfV1≤-0.04mm·s、心影增大、eGFR、LVEF、CK-MB和肌钙蛋白I多因素校正后平面QRS-T夹角≥90°与近期不良结局发生率相关性无统计学意义(HR:1.78,95%CI:0.75~4.22,P=0.19),但仍是远期不良预后的独立预测因素(HR:2.04,95%CI:1.18~3.56,P=0.01)。结论:平面QRS-T夹角≥90°是本研究AHFS队列远期不良预后的独立预测因素,尚不能认为是近期不良预后的预测因素。Abstract: Objective:To assess the prognostic value of planar QRS-T angle in patients with acute heart failure syndrome(AHFS) by analyzing poor outcomes from short-term and long-term follow up.Method:The 125 AHFS patients from 2hospitals were enrolled.These patients were divided into less than 90degrees(<90°) group and greater than or equal to 90degree(≥ 90°) group,based on their first ECG result after admitting to hospital.Poor outcomes were recorded during the 30days(short-term) and 1year(long-term) follow-up.Kaplan-Meier(K-M) curves were used to compare the difference of short-term and long-term poor outcomes from the 2groups.A Cox proportional hazards regression was used as multivariable model to assess the relationship of the planar QRS-T angle ≥ 90°with short and long term outcomes.Result:Mean degrees of planar QRS-T angle were 116.5±46.9°of all patients.There were 92long-term cases of poor outcomes out of 96in ≥ 90°group,and 50 of these cases were also short term poor outcomes.In comparison,there were 19long-term cases of poor outcomes out of 29 in <90°group,and 8of these cases were also short term poor outcomes.Patients with planar QRS-T angle ≥ 90°were more likely have large heart shadow,more P wave terminal force in lead V1(PtfV1) ≤ -0.04mm·s,lower estimated glomerular filtration rate(eGFR),lower left ventricular ejection fraction(LVEF),higher CK-MB and Troponin I.K-M curves for endpoint showed that there were significant difference between ≥ 90°group and <90°group on both short-term and long-term poor outcomes.After multivariable adjustment by enlarge heart shadow,PtfV1 ≤ -0.04mm·s,eGFR,LVEF,CK-MB,and Troponin I in Cox model,the planar QRS-T angle ≥ 90°remain a significant predictor of long-term poor ourcomes(HR:2.04,95%CI:1.18~3.56,P=0.01),but there was no statistical significance in short-term poor outcomes(HR:1.78,95%CI:0.75~4.22,P=0.19).Conclusion:Planar QRS-T angle ≥ 90°is a significant predictor of long-term poor outcomes in our AHFS patients cohort;however,it is not a predictor of short-term poor outcomes.
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Key words:
- planar QRS-T angle /
- acute heart failure syndrome /
- poor outcomes /
- predictor
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[1] 中华心血管病杂志编辑委员会中华医学会心血管病学分会.急性心力衰竭诊断和治疗指南[J].中华心血管病杂志,2010,38(3):195-208.
[2] PANG P S,KOMAJDA M,GHEORGHIADE M.The current and future management of acute heart failure syndromes[J].Eur Heart J,2010,31:784-793.
[3] WEINTRAUB N L,COLLINS S P,PANG P S,et al.Acute heart failure syndromes:emergency department presentation,treatment,and disposition:current approaches and future aims:a scientific statement from the American Heart Association[J].Circulation,2010,122:1975-1996.
[4] 陈玉国.机遇与挑战:急性心力衰竭综合征的诊治现状和展望[J].中华急诊医学杂志,2011,20(7):680
[5] 栾晓军,王国干.急性心力衰竭的流行现状和诊治进展[J].心血管病学进展,2010,31(6):800-804.
[6] WALSH J R,SOLIMAN E Z,ILKHANOFF L,et al.Prognostic value of frontal QRS-T angle in patients without clinical evidence of cardiovascular disease(from the Multi-Ethnic Study of Atherosclerosis)[J].Am J Cardiol,2013,112:1880-1884.
[7] WHANG W,SHIMBO D,LEVITAN E B,et al.Relations between QRS|T angle,cardiac risk factors,and mortality in the third National Health and Nutrition Examination Survey(NHANES III)[J].Am J Cardiol,2012,109:981-987.
[8] PAVRI B B,HILLIS M B,SUBACIUS H,et al.Prognostic value and temporal behavior of the planar QRS-T angle in patients with nonischemic cardiomyopathy[J].Circulation,2008,117:3181-3186.
[9] RAUTAHARJU P M,PRINEAS R J,WOOD J,et al.Electrocardiographic predictors of new-onset heart failure in men and in women free of coronary heart disease(from the Atherosclerosis in Communities[ARIC]Study)[J].Am J Cardiol,2007,100:1437-1441.
[10] JIMENO S A,GIL V,MERINO J,et al.Validity of Framingham criteria as a clinical test for systolic heart failure[J].Rev Clin Esp,2006,206:495-498.
[11] 李艳红,任学军.心电图QRS-T夹角临床意义探讨[J].心肺血管病杂志,2010,29(3):254-256.
[12] 付研.急性心力衰竭进展与实践[J].中华急诊医学杂志,2010,19(8):789-794.
[13] MADIAS J E.The resting electrocardiogram in the management of patients with congestive heart failure:established applications and new insights[J].Pacing Clin Electrophysiol,2007,30:123-128.
[14] Madias J E.Why recording of an electrocardiogram should be required in every inpatient and outpatient encounter of patients with heart failure[J].Pacing Clin Electrophysiol,2011,34:963-967.
[15] SELVARAJ S,ILKHANOFF L,BURKE M A,et al.Association of the frontal QRS-T angle with adverse cardiac remodeling,impaired left and right ventricular function,and worse outcomes in heart failure with preserved ejection fraction[J].J Am Soc Echocardiogr,2014,27:74-82.
[16] RAPOSEIRAS-ROUBIN S,VIRGOS-LAMELA A,BOUZAS-CRUZ N,et al.Usefulness of the QRS-T angle to improve long-term risk stratification of patients with acute myocardial infarction and depressed left ventricular ejection fraction[J].Am J Cardiol,2014,113:1312-1319.
[17] GOTSMAN I,KEREN A,HELLMAN Y,et al.Usefulness of electrocardiographic frontal QRS-T angle to predict increased morbidity and mortality in patients with chronic heart failure[J].Am J Cardiol,2013,111:1452-1459.
[18] KENTTA T,VIIK J,KARSIKAS M,et al.Postexercise recovery of the spatial QRS/T angle as a predictor of sudden cardiac death[J].Heart Rhythm,2012,9:1083-1089.
[19] ARO A L,HUIKURI H V,TIKKANEN J T,et al.QRS-T angle as a predictor of sudden cardiac death in a middle-aged general population[J].Europace,2012,14:872-876.
[20] LOWN M T,MUNYOMBWE T,HARRISON W,et al.Association of frontal QRS-T angle——age risk score on admission electrocardiogram with mortality in patients admitted with an acute coronary syndrome[J].Am J Cardiol,2012,109:307-313.
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