Silverman M E, Pressel M D, Brackett J C, Lauria S S, Gold M R, Gottlieb S S
Division of Cardiology, University of Maryland School of Medicine, Baltimore.
Am J Cardiol. 1995 Mar 1;75(7):460-4. doi: 10.1016/s0002-9149(99)80581-5.
Studies of electrocardiographic predictors of mortality in patients with chronic heart failure have reached varying conclusions. Differences in the characteristics of the patients studied may explain the conflicting results regarding both a prolonged QRS and an abnormal signal-averaged electrocardiogram (SAE). We therefore investigated the impact of the etiology of heart failure on the prognostic importance of a prolonged QRS and an abnormal SAE in 200 patients with heart failure. Patients were categorized according to etiology of heart failure and electrocardiographic parameters. The mortality of patients with a prolonged QRS was compared with mortality in those with both abnormal and normal SAEs. This was done for the entire group, and separately for those with ischemic and those with nonischemic cardiomyopathy. The mean follow-up was 18.8 months. Nonischemic patients with a prolonged QRS had significantly worse survival than other patients. However, nonischemic patients with an abnormal SAE did not have a worse prognosis than patients with a normal SAE. One-year survival of patients with a prolonged QRS was 71%, compared with 98% in patients with a normal and 87% in patients with an abnormal SAE (p < 0.05). In contrast, a prolonged QRS was not a predictor of poor prognosis in patients with ischemic cardiomyopathy (81% one year mortality). Patients with ischemic cardiomyopathy and an abnormal SAE tended to have a poorer survival than patients with a normal SAE (73% and 81% one year mortality, respectively). Thus, the etiology of heart failure affects the prognostic importance of both a prolonged QRS and an abnormal SAE.
关于慢性心力衰竭患者死亡率的心电图预测指标的研究得出了不同结论。所研究患者特征的差异可能解释了在QRS时限延长和信号平均心电图（SAE）异常方面相互矛盾的结果。因此，我们调查了心力衰竭病因对200例心力衰竭患者QRS时限延长和SAE异常的预后重要性的影响。患者根据心力衰竭病因和心电图参数进行分类。将QRS时限延长患者的死亡率与SAE异常和正常患者的死亡率进行比较。对整个组进行了此项比较，并分别对缺血性心肌病患者和非缺血性心肌病患者进行了比较。平均随访时间为18.8个月。QRS时限延长的非缺血性患者的生存率明显低于其他患者。然而，SAE异常的非缺血性患者的预后并不比SAE正常的患者差。QRS时限延长患者的一年生存率为71%，而SAE正常患者为98%，SAE异常患者为87%（p<0.05）。相比之下，QRS时限延长并非缺血性心肌病患者预后不良的预测指标（一年死亡率为81%）。缺血性心肌病且SAE异常的患者的生存率往往比SAE正常的患者差（一年死亡率分别为73%和81%）。因此，心力衰竭的病因会影响QRS时限延长和SAE异常的预后重要性。
