[1]段玉彩,魏亚君,马 凌,等.QRS波时限在射血分数保留性心力衰竭中的相关性研究[J].医学信息,2024,37(03):104-108.[doi:10.3969/j.issn.1006-1959.2024.03.020]
　DUAN Yu-cai,WEI Ya-jun,MA Ling,et al.Correlation Study of QRS Duration in Heart Failure with Preserved Ejection Fraction[J].Journal of Medical Information,2024,37(03):104-108.[doi:10.3969/j.issn.1006-1959.2024.03.020]
点击复制

QRS波时限在射血分数保留性心力衰竭中的相关性研究()
分享到：

医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
37卷
期数:
2024年03期
页码:
104-108
栏目:
论著
出版日期:
2024-02-01

文章信息/Info

Title:
Correlation Study of QRS Duration in Heart Failure with Preserved Ejection Fraction
文章编号:
1006-1959（2024）03-0104-05
作者:
段玉彩; 魏亚君; 马 凌; 等
（1.联勤保障部队第九四〇医院心内科，甘肃 兰州 730000；2.解放军火箭军第64基地医院感染科，甘肃 兰州 730000）
Author(s):
DUAN Yu-cai; WEI Ya-jun; MA Ling; et al.
(1.Department of Cardiology,940th Hospital of Joint Logistics Support Force,Lanzhou 730000,Gansu,China;2.Department of Infectious Diseases,64th Base of PLA Rocket Force,Lanzhou 730000,Gansu,China)
关键词:
QRS波时限; 射血分数保留性心力衰竭; 心力衰竭
Keywords:
RS duration; Heart failure with preserved ejection fraction; Heart failure
分类号:
R541.6
DOI:
10.3969/j.issn.1006-1959.2024.03.020
文献标志码:
A
摘要:
目的 研究QRS波时限在射血分数保留性心力衰竭（HFpEF）中的关系。方法 选取2021年1月-2022年1月就诊于联勤保障部队第九四〇医院的HFpEF患者87例为心衰组，并根据纽约心脏病协会（NYHA）心脏功能分级将心衰组分为Ⅱ~Ⅳ组，另选取同期53名健康体检者为对照组，比较各组临床资料，采用Spearman相关分析QRS波时限与临床各指标的关系，ROC曲线分析QRS波时限诊断HFpEF的效能。结果 各组年龄、BMI、冠心病比例、糖尿病比例、FS比较，差异无统计学意义（P＞0.05）。各组性别、高血压比例、房颤比例、肌酐、QRS、QTC、LVEF、LAD、LVEDV、LVESV、QRS波时限、NT-proBNP比较，差异有统计学意义（P＜0.05）。Spearman相关性分析显示，QRS波时限与年龄、LAD、LVEDV、LVESV、NT-proBNP呈正相关，与LVEF呈负相关（P＜0.05）。ROC曲线显示分析，QRS波时限诊断HFpEF的AUC为0.843（95%CI：0.772~0.915），敏感度和特异度分别为88.50%和71.70%，截点值为98.5 ms；NT-proBNP诊断HFpEF的AUC为0.979（95%CI：0.961~0.998），敏感度和特异度分别为93.10%和96.20%，截点值为619.5 pg/ml。QRS波时限与NT-proBNP联合对HFpEF的诊断价值更高，AUC达0.984（95%CI：0.967~0.100），敏感度和特异度分别为92.00%和98.10%。结论 QRS波时限在HFpEF患者中随着NYHA分级增加而增宽，QRS波时限与NT-proBNP联合检测可有效提高HFpEF的诊断效率。
Abstract:
Objective To study the relationship between QRS duration and heart failure with preserved ejection fraction (HFpEF).Methods A total of 87 patients with HFpEF who were admitted to the 940 th Hospital of Joint Logistics Support Force from January 2021 to January 2022 were selected as the heart failure group, and the heart failure group was divided into groups Ⅱ-Ⅳ according to the New York Heart Association (NYHA) cardiac function classification. In addition, 53 healthy subjects in the same period were selected as the control group. The clinical data of each group were compared. Spearman correlation was used to analyze the relationship between QRS duration and clinical indicators. ROC curve was used to analyze the efficacy of QRS duration in the diagnosis of HFpEF.Results There was no significant difference in age, BMI, proportion of coronary heart disease, proportion of diabetes and FS among the groups (P>0.05), while there were significant differences in gender, proportion of hypertension, proportion of atrial fibrillation, creatinine, QRS, QTC, LVEF, LAD, LVEDV, LVESV, QRS duration and NT-proBNP among the groups (P<0.05). Spearman correlation analysis showed that QRS wave duration was positively correlated with age, LAD, LVEDV, LVESV and NT-proBNP, and negatively correlated with LVEF (P<0.05). ROC curve analysis showed that the AUC of QRS wave duration in the diagnosis of HFpEF was 0.843(95%CI:0.772-0.915), the sensitivity and specificity were 88.50% and 71.70%, respectively, and the cut-off value was 98.5 ms; the AUC of NT-proBNP in the diagnosis of HFpEF was 0.979(95%CI:0.961-0.998), the sensitivity and specificity were 93.10% and 96.20%, respectively, and the cut-off value was 619.5 pg/ml; the combination of QRS duration and NT-proBNP had higher diagnostic value for HFpEF, with AUC of 0.984(95%CI:0.967-0.100), sensitivity and specificity of 92.00% and 98.10%, respectively.Conclusion The QRS duration in patients with HFpEF increases with the increase of NYHA classification. The combined detection of QRS duration and NT-proBNP can effectively improve the diagnostic efficiency of HFpEF.

参考文献/References:

[1]Zhang Y,Zhang J,Butler J,et al.Contemporary Epidemiology,Management,and Outcomes of Patients Hospitalized for Heart Failure in China: Results From the China Heart Failure （China-HF） Registry[J].J Card Fail,2017,23(12):868-875.[2]Hummel SL,Skorcz S,Koelling TM.Prolonged electrocardiogram QRS duration independently predicts long-term mortality in patients hospitalized for heart failure with preserved systolic function[J].J Card Fail,2009,15(7):553-560.[3]Kitzman DW,Upadhya B,Felker GM.A Biomarker Approach to Understanding HFpEF[J].J Am Coll Cardiol,2020,75(11):1296-1298.[4]中华医学会心血管病学分会心力衰竭学组,中国医师协会心力衰竭专业委员会,中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2018[J].中华心血管病杂志,2018,46(10):760-789.[5]Murdoch CE,Chaubey S,Zeng L,et al.Endothelial NADPH oxidase-2 promotes interstitial cardiac fibrosis and diastolic dysfunction through proinflammatory effects and endothelial-mesenchymal transition[J].J Am Coll Cardiol,2014,63(24):2734-2741.[6]Lam CSP,Voors AA,de Boer RA,et al.Heart failure with preserved ejection fraction: from mechanisms to therapies[J].Eur Heart J,2018,39(30):2780-2792.[7]Dunlay SM,Roger VL,Redfield MM.Epidemiology of heart failure with preserved ejection fraction[J].Nat Rev Cardiol,2017,14(10):591-602.[8]Kotecha D,Lam CS,Van Veldhuisen DJ,et al.Heart Failure With Preserved Ejection Fraction and Atrial Fibrillation:Vicious Twins[J].J Am Coll Cardiol,2016,68(20):2217-2228.[9]韩彤亮,康维强.超声心动图评价舒张性心力衰竭的适用标准与合理应用[J].中国循环杂志,2013,28(2):160-160.[10]任庆文,张小玲,王翠翠.射血分数保留心力衰竭患者尿白蛋白/肌酐比与左心室功能的相关性分析[J].安徽医科大学学报,2019,54(8):1299-1304.[11]Yamaguchi K,Yoshitomi H,Ito S,et al.Left atrial remodeling and recurrence of congestive heart failure in patients initially diagnosed with heart failure[J].Echocardiography,2014,31(8):936-940.[12]Cikes M,Claggett B,Shah AM,et al.Atrial Fibrillation in Heart Failure With Preserved Ejection Fraction: The TOPCAT Trial[J].JACC Heart Fail,2018,6(8):689-697.[13]Almeida AG.NT-proBNP and Myocardial Fibrosis: The Invisible Link Between Health and Disease[J].J Am Coll Cardiol,2017,70(25):3110-3112.[14]Ponikowski P,Voors AA,Anker SD,et al.2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC[J].Eur Heart J,2016,37(27):2129-2200.[15]李达波.QRS间期延长预测射血分数保留性心力衰竭患者预后的价值[J].中国循证心血管医学杂志,2016,8(12):1483-1485.[16]易莉莎,武庆平,谢飞,等.QRS间期与射血分数保留性心力衰竭患者长期预后的关系[J].华中科技大学学报(医学版),2014,43(1):83-85.[17]Joseph J,Claggett BC,Anand IS,et al.QRS Duration Is a Predictor of Adverse Outcomes in Heart Failure With Preserved Ejection Fraction[J].JACC Heart Fail,2016,4(6):477-486.[18]Lund LH,Jurga J,Edner M,et al.Prevalence,correlates,and prognostic significance of QRS prolongation in heart failure with reduced and preserved ejection fraction[J].Eur Heart J,2013,34(7):529-539.[19]Dhingra R,Ho Nam B,Benjamin EJ,et al.Cross-sectional relations of electrocardiographic QRS duration to left ventricular dimensions: the Framingham Heart Study[J].J Am Coll Cardiol,2005,45(5):685-689.

相似文献/References:

[1]李 涛,黄国才.射血分数保留性心力衰竭患者脑钠肽水平的临床意义及与左心房的相关性分析[J].医学信息,2021,34(23):181.[doi:10.3969/j.issn.1006-1959.2021.23.055]
　LI Tao,HUANG Guo-cai.Clinical Significance of Brain Natriuretic Peptide Level in Patients with Heart Failure with Preserved Ejection Fraction and its Correlation with Left Atrium[J].Journal of Medical Information,2021,34(03):181.[doi:10.3969/j.issn.1006-1959.2021.23.055]

更新日期/Last Update: 1900-01-01