Coulibaly I, N'Djessan J J, Adoubi A, Yao H, Gbetchedji S, Soya E, Ncho-Mottoh M P, Angoran I, Kouamé S, Tro G, Touré C, Anzouan-Kacou J B
Service d'hospitalisation de médecine, Institut de Cardiologie d'Abidjan, Côte d'Ivoire.
Unité de Soins Intensifs Cardiologiques, Institut de Cardiologie d'Abidjan, Côte d'Ivoire.
Ann Cardiol Angeiol (Paris). 2024 Feb;73(1):101628. doi: 10.1016/j.ancard.2023.101628. Epub 2023 Nov 18.
Heart failure with impaired ejection fraction (HFIEF) represents the end-stage of most cardiac diseases, and is responsible for a high mortality rate. In order to identify patients at risk, numerous clinical and paraclinical prognostic factors have been proposed. The electrocardiogram (ECG), easy to perform and inexpensive, retains a powerful role in the prognostic evaluation of heart failure patients. The aim was to evaluate ECG signs associated with mortality in a retrospective cohort of patients with ICFEA.
The study was observational and analytical based on retrospective data collected from patients benefiting from a primary hospitalization for ICFEA at the Abidjan Heart Institute from January 2018 to July 2020.
Of the 370 patients included, 197 had died by August 1, 2020, representing an overall mortality of 53%. Mortality progressed gradually up to one year, then remained unchanged up to 30 months. In multivariate Cox regression including ECG variables only, the presence of intra-ventricular conduction disorders (OR: 1.80; 95% CI [1.01-3.25]), microvoltage (OR: 1.82; 95% CI [1.05-16]), and pathological Q waves (OR: 1.70; 95% CI [1.02-2.83]), were significantly associated with overall mortality. When ECG variables and clinical, paraclinical and therapeutic demographic variables were included, only the presence of pathological Q waves (OR:1.74; 95% CI [1.01-3.01]) persisted as a risk factor for mortality. Hypertension and treatment of heart failure, in particular ACEI/ARII, beta-blockers and ARM, were protective factors. The presence of Q waves was associated with a significant reduction in survival, based on curves obtained using the Kaplan-Meier model.
ICFEA is responsible for high mortality, mainly in the year following the 1 hospitalization for cardiac decompensation. The presence of pathological Q waves is the only electrocardiographic sign that remains statistically associated with a poor prognosis, after adjustment.
射血分数降低的心力衰竭（HFIEF）是大多数心脏病的终末期，死亡率很高。为了识别有风险的患者，人们提出了许多临床和临床旁预后因素。心电图（ECG）操作简便且成本低廉，在心力衰竭患者的预后评估中仍发挥着重要作用。本研究旨在评估在一个回顾性队列中，与射血分数降低的心力衰竭患者死亡率相关的心电图特征。
本研究基于从2018年1月至2020年7月在阿比让心脏研究所因射血分数降低的心力衰竭首次住院的患者收集的回顾性数据进行观察性和分析性研究。
在纳入的370例患者中，截至2020年8月1日，197例患者死亡，总死亡率为53%。死亡率在1年内逐渐上升，然后在30个月内保持不变。在仅包括心电图变量的多变量Cox回归中，室内传导障碍（OR：1.80；95%可信区间[1.01-3.25]）、低电压（OR：1.82；95%可信区间[1.05-1.6]）和病理性Q波（OR：1.70；95%可信区间[1.02-2.83]）与总死亡率显著相关。当纳入心电图变量以及临床、临床旁和治疗人口统计学变量时，只有病理性Q波（OR：1.74；95%可信区间[1.01-3.01]）仍然是死亡率的危险因素。高血压以及心力衰竭的治疗，特别是ACEI/ARII、β受体阻滞剂和醛固酮受体拮抗剂，是保护因素。根据使用Kaplan-Meier模型获得的曲线，Q波的存在与生存率的显著降低相关。
射血分数降低的心力衰竭导致高死亡率，主要发生在因心脏失代偿首次住院后的一年内。病理性Q波的存在是调整后唯一仍与不良预后有统计学关联的心电图特征。
