Cui Xiaoran, Liu Demin, Geng Xue, Wang Qian, Li Ruibin, Zhou Wenli, Cui Wei
Department of Cardiology, The Second Hospital of Hebei Medical University, 050004 Shijiazhuang, Hebei, China.
Rev Cardiovasc Med. 2022 Jun 27;23(7):241. doi: 10.31083/j.rcm2307241. eCollection 2022 Jul.
The QRS fraction is the ratio of the total amplitude of R waves to the total amplitude of QRS complexes ( R/QRS) on a 12-lead electrocardiogram. Our group has previously proposed calculation of the QRS fraction as a simple method for estimation of left ventricular ejection fraction. In this study, we explored the ability of the QRS fraction to predict cardiovascular death in patients with heart failure.
The study had a prospective, observational design and collected epidemiological and follow-up data for 1715 patients with heart failure who were inpatients in the Department of Cardiology at the Second Hospital of Hebei Medical University between January 2017 and December 2018. The patients were stratified according to quartile of QRS fraction, namely, lower ( 43.8%, Q1 group) middle (43.8%-61.0%, Q2 group), and higher ( 61.0%, Q3 group).
One thousand and fifty-one (61.28%) of the 1715 patients were male and the median follow-up duration was 261 days (interquartile range 39, 502). There were 341 (19.88%) deaths, including 282 (16.44%) with a cardiovascular cause. The Q1, Q2, and Q3 groups comprised 431 (25.13%), 850 (49.56%), and 434 (25.31%) patients, respectively. There were significant differences in cardiovascular mortality among the three QRS fraction subgroups ( 0.05). Kaplan-Meier survival curves of different QRS fraction levels showed significant diffference among patients with heart failure, especially among those with preserved ejection fraction ( = 0.025 and 0.031, log-rank test). Cox regression analysis showed that the QRS fraction was independently associated with the risk of cardiovascular death. The risk of cardiovascular death was lower in the Q2 and Q3 groups than in the Q1 group, with respective hazard ratios of 0.668 (95% confidence interval 0.457-0.974) and 0.538 (95% confidence interval 0.341-0.849).
The QRS fraction may serve as a prognostic indicator of the long-term risk of cardiovascular death in patients with heart failure, especially those with preserved ejection fraction.
ChiCTR-POC-17014020.
QRS波分数是12导联心电图上R波总振幅与QRS波群总振幅的比值（R/QRS）。我们团队之前提出计算QRS波分数作为评估左心室射血分数的一种简单方法。在本研究中，我们探讨了QRS波分数预测心力衰竭患者心血管死亡的能力。
本研究采用前瞻性观察性设计，收集了2017年1月至2018年12月在河北医科大学第二医院心内科住院的1715例心力衰竭患者的流行病学和随访数据。根据QRS波分数的四分位数对患者进行分层，即较低（≤43.8%，Q1组）、中等（43.8% - 61.0%，Q2组）和较高（＞61.0%，Q3组）。
1715例患者中1051例（61.28%）为男性，中位随访时间为261天（四分位间距39，502）。有341例（19.88%）死亡，其中282例（16.44%）为心血管原因导致。Q1、Q2和Q3组分别包括431例（25.13%）、850例（49.56%）和434例（25.31%）患者。三个QRS波分数亚组之间的心血管死亡率存在显著差异（P＜0.05）。不同QRS波分数水平的Kaplan - Meier生存曲线显示心力衰竭患者之间存在显著差异，尤其是射血分数保留的患者（P = 0.025和0.031，对数秩检验）。Cox回归分析表明，QRS波分数与心血管死亡风险独立相关。Q2组和Q3组的心血管死亡风险低于Q1组，危险比分别为0.668（95%置信区间0.457 - 0.974）和0.538（%置信区间0.341 - 0.849）。
QRS波分数可作为心力衰竭患者心血管死亡长期风险的预后指标，尤其是射血分数保留的患者。
ChiCTR - POC - 17014020。
