Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan.
Department of Pathobiological Science and Technology, School of Health Science; Major in Clinical Laboratory Science, Faculty of Medicine, Tottori University, Yonago, Japan.
ESC Heart Fail. 2022 Apr;9(2):1098-1106. doi: 10.1002/ehf2.13778. Epub 2022 Jan 25.
Increased left ventricular mass index (LVMI) disproportionate to electrocardiographic QRS voltage has been reported to be associated with cardiac fibrosis and amyloid infiltration to myocardium. This study aimed to assess whether the LVMI-to-QRS-voltage ratio predicts clinical outcomes in heart failure with preserved ejection fraction (HFpEF).
The Japanese Heart Failure Syndrome with Preserved Ejection Fraction (JASPER) registry is a nationwide, observational, and prospective registration of Japanese patients hospitalized with HFpEF (EF ≥ 50%). LVMI was assessed by echocardiography using the cube formula. QRS voltage was assessed by Sokolow-Lyon voltage criteria. We divided 290 patients in the registry who met inclusion criteria into five groups according to the quintile values of their LVMI-to-QRS-voltage ratio. In the highest quintile group (≥71.8 g/m /mV), approximately 50% of the patients had concentric hypertrophy and 30% had eccentric hypertrophy. These patients had the highest proportion of atrial fibrillation (61.4%) and history of pacemaker implantation (12.1%) among the five groups (P < 0.05). During the mean follow-up of 587 ± 300 days, 31.4% of all patients met the composite endpoint of all-cause death or rehospitalization for HF. Even after adjustment for demographic and baseline variables, the highest quintile group had a significantly higher incidence of the composite endpoints than the lowest quintile group (<30.7 g/m /mV) (hazard ratio: 2.205, 95% confidence interval: 1.106-4.395, P < 0.05).
A high LVMI-to-QRS-voltage ratio is independently associated with poor outcomes in patients with HFpEF.
与心肌纤维化和淀粉样物质浸润有关的左心室质量指数（LVMI）不成比例增加，心电图 QRS 电压已被报道。本研究旨在评估 LVMI 与 QRS 电压比值是否可预测射血分数保留的心衰（HFpEF）患者的临床结局。
日本射血分数保留心衰综合征（JASPER）注册研究是一项全国性、观察性和前瞻性登记研究，纳入了因 HFpEF（EF≥50%）住院的日本患者。LVMI 通过超声心动图应用体表面积校正的立方公式进行评估。QRS 电压通过 Sokolow-Lyon 电压标准进行评估。我们根据 LVMI 与 QRS 电压比值的五分位值将登记研究中符合纳入标准的 290 例患者分为五组。在比值最高的五分位组（≥71.8g/m/mV）中，约 50%的患者存在向心性肥厚，30%存在偏心性肥厚。与其他五组相比，该组患者心房颤动（61.4%）和起搏器植入史（12.1%）的比例最高（P<0.05）。在平均 587±300 天的随访期间，所有患者中有 31.4%达到了全因死亡或因心衰再住院的复合终点。即使在校正了人口统计学和基线变量后，比值最高的五分位组的复合终点发生率仍显著高于比值最低的五分位组（<30.7g/m/mV）（风险比：2.205，95%置信区间：1.106-4.395，P<0.05）。
HFpEF 患者的 LVMI 与 QRS 电压比值较高与不良结局独立相关。
