Hu Ying, Jiang Shifeng, Lu Siyuan, Xu Rong, Huang Yunping, Zhao Zongliang, Qu Yi
Department of Geriatrics, Xuhui District Central Hospital Department of Geriatrics, Qingpu Branch of Zhongshan Hospital, Fudan University Geriatric Nursing Services, Xuhui District Tianlin Street Community Health Service Center General, Shanghai, China.
Medicine (Baltimore). 2017 Jun;96(26):e7071. doi: 10.1097/MD.0000000000007071.
The aim of our study was to determine whether combinations of ultrasound echocardiography (UCG) and electrocardiography (EKG) parameters correlated with the functional status of ischemic cardiomyopathy (ICM) patients according to the New York Heart Association (NYHA) classification system.We assessed 536 elderly Chinese ICM patients according to the NYHA criteria, which included 196 patients with type 2 diabetes mellitus (T2DM). All of the patients underwent UCG. Transmural dispersion of ventricular repolarization was examined using EKG. Cumulative odds logistic regression was performed to evaluate associations between NYHA class and the demographic, clinical, UCG, and EKG variables based on the odds ratio (OR) and 95% confidence interval (CI). A Pearson analysis was also performed to examine correlations between the NYHA classification and the UCG and EKG variables.Based on the NYHA assessment, 140, 147, 138, and 111 patients were identified as class I, II, III and IV, respectively. A comparison of UCG and EKG variables based on T2DM status showed that CO and Tp-e differed significantly between all NYHA classes (P < .05 for all), with values of each increasing with increasing NYHA class regardless of T2DM status. Multivariate logistic regression analysis showed that the disease course (OR: 1.30; 95% CI: 1.20-1.40), heart rate (OR: 1.16; 95% CI: 1.12-1.21), T wave peak to endpoint (Tp-e; OR: 1.22; 95% CI: 1.18-1.27), dispersion of the QT interval (OR: 0.98; 95% CI: 0.95-1.22), left ventricular fractional shortening (OR: 0.82; 95% CI: 0.78-0.87), cardiac output (CO; OR: 5.58; 95% CI: 3.08-10.13) were significantly associated with the NYHA class (P < .0001 for all). A Pearson correlation analysis showed that Tp-e (r = 0.75982, P < .0001), CO (r = 0.56072, P < .0001), and stroke volume (r = -0.14839, P = .0006) significantly correlated with the NYHA class.An index consisting of Tp-e and CO will be useful for corroborating the results of the NYHA assessment of ICM patients.
我们研究的目的是根据纽约心脏协会(NYHA)分类系统,确定超声心动图(UCG)和心电图(EKG)参数的组合是否与缺血性心肌病(ICM)患者的功能状态相关。我们根据NYHA标准评估了536例中国老年ICM患者,其中包括196例2型糖尿病(T2DM)患者。所有患者均接受了UCG检查。使用EKG检查心室复极的透壁离散度。基于比值比(OR)和95%置信区间(CI),进行累积比值逻辑回归以评估NYHA分级与人口统计学、临床、UCG和EKG变量之间的关联。还进行了Pearson分析以检查NYHA分级与UCG和EKG变量之间的相关性。
根据NYHA评估,分别有140、147、138和111例患者被确定为I级、II级、III级和IV级。基于T2DM状态对UCG和EKG变量进行比较,结果显示所有NYHA分级之间的CO和Tp-e差异均有统计学意义(所有P<0.05),无论T2DM状态如何,各值均随NYHA分级增加而升高。多因素逻辑回归分析显示,病程(OR:1.30;95%CI:1.20-1.40)、心率(OR:1.16;95%CI:1.12-1.21)、T波峰到终点(Tp-e;OR:1.22;95%CI:1.18-1.27)、QT间期离散度(OR:0.98;95%CI:0.95-1.22)、左心室缩短分数(OR:0.82;95%CI:0.78-0.87)以及心输出量(CO;OR:5.58;95%CI:3.08-10.13)均与NYHA分级显著相关(所有P<0.0001)。Pearson相关性分析显示,Tp-e(r=0.75982,P<0.0001)、CO(r=0.56072,P<0.0001)和每搏输出量(r=-0.14839,P=0.0006)与NYHA分级显著相关。
由Tp-e和CO组成的指标将有助于证实NYHA对ICM患者评估的结果。