额面 QRS-T 角与射血分数保留心力衰竭不良心脏重构、左心室和右心室功能障碍及预后恶化的关系。
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.
机构信息
Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.
出版信息
J Am Soc Echocardiogr. 2014 Jan;27(1):74-82.e2. doi: 10.1016/j.echo.2013.08.023. Epub 2013 Sep 27.
BACKGROUND
No prior studies have investigated the association of QRS-T angle with cardiac structure and function and outcomes in heart failure with preserved ejection fraction (HFpEF). The aim of this study was to test the hypothesis that increased frontal QRS-T angle is associated with worse cardiac function and remodeling and adverse outcomes in HFpEF.
METHODS
A total of 376 patients with HFpEF (i.e., symptomatic heart failure with left ventricular ejection fraction > 50%) were prospectively studied. The frontal QRS-T angle was calculated from the 12-lead electrocardiogram. Patients were divided into tertiles by frontal QRS-T angle (0°-26°, 27°-75°, and 76°-179°), and clinical, laboratory, and echocardiographic data were compared among groups. Cox proportional-hazards analyses were performed to determine the association between QRS-T angle and outcomes.
RESULTS
The mean age of the cohort was 64 ± 13 years, 65% were women, and the mean QRS-T angle was 61 ± 51°. Patients with increased QRS-T angles were older; had lower body mass indices; more frequently had coronary artery disease, diabetes, chronic kidney disease, and atrial fibrillation; and had higher B-type natriuretic peptide levels (P < .05 for all comparisons). After multivariate adjustment, patients with increased QRS-T angles had higher B-type natriuretic peptide levels in addition to higher left ventricular mass indices, worse diastolic function parameters, more right ventricular remodeling, and worse right ventricular systolic function (P < .05 for all associations). QRS-T angle was independently associated with the composite outcome of cardiovascular hospitalization or death on multivariate analysis, even after adjusting for B-type natriuretic peptide (heart rate for the highest QRS-T tertile, 2.0; 95% confidence interval, 1.2-3.4; P = .008).
CONCLUSIONS
In HFpEF, increased QRS-T angle is independently associated with worse left and right ventricular function and remodeling and adverse outcomes.
背景
目前尚无研究探讨 QRS-T 角与射血分数保留的心力衰竭（HFpEF）患者心脏结构和功能及预后的相关性。本研究旨在验证以下假设，即额面 QRS-T 角增大与 HFpEF 患者心功能和重构恶化以及不良预后相关。
方法
前瞻性研究了 376 例 HFpEF 患者（即左心室射血分数>50%的有症状心力衰竭）。从 12 导联心电图计算额面 QRS-T 角。根据额面 QRS-T 角将患者分为三分位（0°-26°、27°-75°和 76°-179°），并比较各组间的临床、实验室和超声心动图数据。采用 Cox 比例风险回归分析确定 QRS-T 角与结局之间的相关性。
结果
该队列的平均年龄为 64±13 岁，65%为女性，平均 QRS-T 角为 61±51°。QRS-T 角增大的患者年龄更大；体重指数更低；更常患有冠状动脉疾病、糖尿病、慢性肾脏病和心房颤动；B 型利钠肽水平更高（所有比较均 P<0.05）。多变量调整后，除左心室质量指数更高、舒张功能参数更差、右心室重构更严重以及右心室收缩功能更差外，QRS-T 角增大的患者 B 型利钠肽水平也更高（所有相关性均 P<0.05）。即使在校正 B 型利钠肽后，QRS-T 角仍与心血管住院或死亡的复合结局独立相关（QRS-T 角最高三分位的心率为 2.0；95%置信区间为 1.2-3.4；P=0.008）。
结论
在 HFpEF 中，额面 QRS-T 角增大与左、右心室功能和重构恶化以及不良预后独立相关。
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