Sakhnova T A, Blinova E V, Yurasova E S, Uskach T M, Blinova N V, Aidu E A, Trunov V G, Saidova M A
Chazov National Medical Research Center of Cardiology.
Kharkevich Institute for Information Transmission Problems.
Ter Arkh. 2022 Oct 24;94(9):1067-1071. doi: 10.26442/00403660.2022.09.201843.
To explore the features of vectorcardiograms (VCG) of patients with essential hypertension complicated by chronic heart failure with reduced left ventricular ejection fraction (CHFrLVEF).
We analyzed VCGs of 70 hypertensive patients with CHFrLVEF and 275 hypertensive patients without clinical signs of CHF and with LVEF50%. We assessed the presence of rhythm and conduction disturbances, and the parameters of the synthesized VCG, i.e., module of the maximum QRS vector, planarity index of the spatial QRS loop (P/S), and spatial angle between the integral QRS and T vectors (sQRS-Ta).
In hypertensive patients with CHF, certain conditions were detected more often as compared with hypertensive patients without CHF, i.e., atrial fibrillation (AF) in 52.9% vs 5.1%; p0.0001, and left bundle branch block (LBBB) in 38.6% vs 0.4%; p0.0001. The module of the maximum QRS vector and sQRS-Ta were significantly greater and P/S was significantly less in VCGs of patients with CHF. ROC-analysis showed that the presence of AF and LBBB just as VCG parameters assessed in this study provide clear discrimination between hypertensive patients with or without CHF both in the group as a whole and in the subgroups (1) without LBBB, (2) with sinus rhythm, and (3) with AF. sQRS-Ta was the most informative parameter (threshold 137, sensitivity 91%, specificity 92%). The P/S indicator at the optimal threshold value 0.92 was characterized by lower specificity (68%) with rather high sensitivity (79%).
AF, LBBB, increased module of the maximum QRS vector and sQRS-Ta, and decreased P/S index are present in hypertensive patients with CHFrLVEF as compared with patients without CHF.
探讨原发性高血压合并左心室射血分数降低的慢性心力衰竭（CHFrLVEF）患者的向量心电图（VCG）特征。
我们分析了70例患有CHFrLVEF的高血压患者以及275例无CHF临床体征且左心室射血分数（LVEF）≥50%的高血压患者的VCG。我们评估了节律和传导障碍的存在情况，以及合成VCG的参数，即最大QRS向量模块、空间QRS环的平面度指数（P/S）和积分QRS与T向量之间的空间夹角（sQRS-Ta）。
与无CHF的高血压患者相比，CHF高血压患者中某些情况的检出率更高，即心房颤动（AF）为52.9% 对5.1%；p<0.0001，左束支传导阻滞（LBBB）为38.6% 对0.4%；p<0.0001。CHF患者的VCG中，最大QRS向量模块和sQRS-Ta显著更大，而P/S显著更小。ROC分析表明，AF和LBBB的存在以及本研究中评估的VCG参数在整个组以及亚组（1）无LBBB、（2）窦性心律和（3）AF中均能清晰区分有或无CHF的高血压患者。sQRS-Ta是最具信息量的参数（阈值为137，敏感性为91%，特异性为92%）。最佳阈值为0.92时，P/S指标的特异性较低（68%），但敏感性较高（79%）。
与无CHF的患者相比，CHFrLVEF高血压患者存在AF、LBBB、最大QRS向量模块增加和sQRS-Ta增加以及P/S指数降低的情况。
