间隔q波在老年慢性心力衰竭患者预后中的意义

目的　探讨间隔 q波在老年慢性心力衰竭 (chronicheartfailure ,CHF)患者预后中的意义。 方法　 10 2例心功能 (NYHA分级 )Ⅱ Ⅳ级和左室射血分数 <4 5 %的老年慢性心力衰竭患者纳入研究。根据标准 12导联心电图(ECG)在I,aVL ,V5,V6导联上有或无间隔 q波分组。平均随访 4年 ,研究终点为病死率。 结果　 10 2例CHF患者中有间隔 q波 37例 ;无间隔 q波 6 5例。总病死率39.2 % (n =4 0 )。无间隔 q波组CHF患者病死率5 2 .3% (n =34) ;有间隔 q波组CHF患者中有病死率16 .2 % (n =6 )。无间隔 q波组CHF患者病死率显著高于有间隔 q波组 (χ2 =12 .885 ,P <0 .0 0 1)。Cox多变量分析无间隔q波是预测老年CHF患者病死率的指标 (P =0 .0 0 3,危险率 2 .8,95 %CI 1.2 16～ 5 .6 84 )。结论　标准 12导联ECG无间隔 q波是CHF患者不良预后独立的预测指标 ,提示心脏结构性病变和心肌纤维化。     

QRS波时间延长在老年心力衰竭中的意义

目的 了解心电图QRS波时间延长在老年心力衰竭中的临床意义.方法 将入选的410例老年心力衰竭患者按心电图QRS波时间分为≥120 ms组(n=83)和＜120 ms组(n =327),比较两组患者QRS波时间与左心室射血分数(LVEF)、左室短轴缩短分数(LVFS)、左心房(LAD)左心室(LVEDd)内径、左室壁厚度及NYHA心功能分级.结果 ①＜120 ms组LVEF及LVFS均值大于≥120 ms组(P＜0.01);②≥120 ms组LAD、LVEDd均值大于＜120ms组(P＜0.05或P＜0.01);③＜120ms组的左室壁厚度略大于≥120 ms组,≥120 ms组的NYHA心功能分级Ⅲ、Ⅳ级所占比例略高于＜120 ms组,但差异均无统计学意义(P均＞0.05).结论 心电图QRS波时间对判断老年心力衰竭患者病情具有一定临床意义.     

QRS波时限对慢性心力衰竭心血管事件的预测价值

慢性心力衰竭（chronic heart failure,CHF）是指各种心脏疾病导致心功能不全的一种综合征,是一种严重危害人类健康的疾病.随着新药物投入使用、医疗技术的发展以及人们对CHF认识的不断深入,CHF的治疗水平逐步提高,但由于人口老龄化程度逐年加重和心肌梗死后生存率的日益提高,近几十年CHF的发病率仍然保持在恒定的水平.在美国,每年发病人数为650 000,其中年龄≥40岁的心力衰竭患病率为20％,估计到2050年,每5例老年人中（年龄＞65岁）有1例CHF患者.我国成人CHF患病率为0.9％,其中,男性为0.7％,女性为1.0％,目前我国35～74岁成年人中CHF患者约400万.     

QRS波群时限延长在心力衰竭中的临床意义

目的探讨心电图QRS波群时限延长在心力衰竭患者中的临床意义,指导判断预后及治疗。方法入选110例心力衰竭患者,根据QRS波群时限分为≥120m s组和〈120m s组,分析两组QRS波时限与NYHA心功能分级,左心室舒张末期内径（LVEDd）,左室射血分数（EF）,左室短轴缩短分数（LVFS）,恶性心律失常发生率、死亡率的关系。结果 QRS波群时限≥120m s组患者左心室舒张末期内径,左室射血分数,左室短轴缩短分数,恶性心律失常发生率、1年内死亡率与正常QRS波宽度组心力衰竭患者对照明显恶化,统计学差异有显著性（P〈0.05）。结论 QRS波群时限延长（≥120m s）可作为心力衰竭患者病情严重程度及预后不良的评估方法。     

慢性心力衰竭患者心电图QRS波时限与预后的关系

目的探讨慢性心力衰竭患者心电图QRS波时限与其远期预后的关系。方法选取慢性心力衰竭患者100例,收集所有患者体表心电图QRS波时限、血清生化检测结果、超声心电图以及一般临床资料,根据QRS波时限的不同分为窄时限组(QRS波时限≤95ms)30例、中时限组(95ms     

实时三维超声心动图评价QRS时限对心力衰竭患者左心室收缩同步性的影响

目的 应用实时三维超声心动图(RT-3DE)分析并评价ORS时限对心力衰竭(心衰)患者左心室收缩同步性的影响.方法选取34例左室射血分数(LVEF)≤35%的心衰患者,其中QRS时限正常者(A组)20例,QRS延长者(B组)14例,分别行二维及三维超声心动图检查,获取二维LVEF、左室舒张未内径(LVIDd),三维所测收缩末容积(LVESV)及舒张末容积(LVEDV)、LVEF及校正的16节段不同步指数(Tmsvl6-sd/RR),各组问结果进行分析对比.结果 A组二维参数LVIDd、LVEF与B组相比差异无统计学意义(P＞0.05),三维参数中LVESV、LVEDV、LVEF及Tmsv16-sd/RR.B组略高于A组,但差异亦无统计学意义(P＞0.05).结论实时三维超声心动图可定量评价整体左室收缩的同步性,QRS时限的长短对左室各节段机械收缩的同步性并无显著影响.     

慢性心力衰竭患者QRS波群时限与心室不同步性关系的临床研究

目的应用普通超声心动图及组织多普勒成像技术探讨慢性心力衰竭患者QRS波群时限与心室收缩的不同步性关系。方法96例慢性心力衰竭患者根据QRS波群时限分三组,组IQRS波群时限〈120ms,组ⅡQRS波群时限≥120ms,〈150ms,组111QRS波群时限≥150ms。应用多普勒超声心动图分别测量QRS波群起点至主动脉、肺动脉前向血流频谱开始的时间间期,二者的差值为左右心室间电机械延迟（IVMD）,应用组织多普勒测量左房室环各部位左室收缩期电机械运动时间的离散度。结果三组受试者不论QRS波群宽度均存在心室间（分别为13．9％、53．8％、68．1％,P〈0．05）或心室内（分别为30．6％、61．5％、72．3％,P〈0．05）不同步现象。一部分QRS波群正常或轻度增宽的慢性心力衰竭患者也表现出心室间或心室内的不同步性（13．9％、30．6％）。QRS时限越长,存在不同步的比例越高。QRS波群时限与IVMD呈正相关（r=0．66,P〈0．01）。结论部分QRS波群正常或轻度延长慢性心力衰竭患者也存在心室间或心室内的不同步性。联合应用普通超声心动图和组织多普勒技术可以用来评价心肌运动的不同步性。     

慢性心力衰竭患者左右心室收缩同步性与心电图关系研究

目的 观察窦性心律慢性心力衰竭患者左右心室收缩同步性差异,以及窦性心律慢性心力衰竭患者心电图、左心室收缩功能的变化.探讨双心室收缩差异的发生率、双心室收缩差异的预测指标、双心室收缩不同步与左心室收缩功能的关系.方法 选择26例慢性心力衰竭患者和16例健康对照者.首先进行心电图检查获得QRS间期,P-R间期.再进行平衡状放射性核素心室造影检查,获得左、右心室射血分数及其他功能参数,在相位直方图上计算左右心室的相角程、半高宽.结果 两组间心电图参数QRS间期、P-R间期差异有统计学意义,(117.64±33.16)ms vs(91.87±9.16)ms,(191.43±55.25)ms vs(161.75±22.17)ms(均P<0.05).位相分析中左右心室相角程及半高宽差异有统计学意义,(86.56±21.88)°vs(223.81±101.41)°,(26.44±8.21)°vs(57.90±42.72)°(均P<0.01).慢性心力衰竭患者左右心室相角程(PS)与LVEF呈相关(r=-0.709,P<0.001);左右心室相角程(PS)与心电图QRS间期无相关性(r＝0.310,P>0.05).病例组76.9%的患者存在室间不同步收缩,存在室间不同步收缩患者与无室间不同步收缩患者相比,左、右心室射血分数差异有统计学意义(P<0.01);心电图、参数差异无统计学意义(P>0.05).这些患者室间不同步收缩PS与LVEF(r＝-0.55,P<0.05);而与心电图的QRS间期无明显相关关系(r=0.090,P>0.05).结论 慢性心力衰竭患者的心电图、功能参数、位相分析参数存在着明显异常;76.9%心力衰竭患者存在着室间非同步收缩,这些患者具有较低的射血分数;室间非同步收缩与左心功能呈明显负相关,与QRS间期无明显相关关系.室间非同步收缩的形成可能是导致心功能下降的原因之一. 缩患者相比,左、右心室射血分数差异有统计学意义(P<0.01);心电图、参数差异无统计学意义(P>0.05).这些患者室间不同步收缩PS与LVEF(r＝-0.55,P<0.05);而与心电图的QRS问期无明显相关关系(r=0.090,P>0.05).结论 慢性心力衰竭患者的心电图、功能参数、位相分析参数存在着明显异常;76.9%心力衰竭患者存在着室间非同步收缩,这些患者具有较低的射血分数;室间非同步收缩与左心功能呈明显负相关,与QRS间期 明显相关关系.室间非同步收缩的形成可能是导致心功能下降的原因之一. 缩患者相比,左、右心室射血分数差异有统计学意义(P<0.01);心电图、参数差异无统计学意义(P>0.05).这些患者室间不同步收缩PS与LVEF(r＝-0.55,P<0.05);而与心电图的QRS问期无明显相关关系(r=0.090,P>0.05).结论 慢性心力衰竭患者的心电图、功能参数、位相分析参数存在着明显异常;76.9%心力衰竭患者存在着室间非同步收缩,这些患者具有较低的射血分数;室间非同步收缩与左心功能呈明显负相关,与QRS间期 明显相关关系.室间非同步收缩的形成可能是导致心功

Abstract：

Objective To observe contraction desynchronization of entire ventricle, alterations of electrocardiography and left ventricular systolic function in patients with chronic congestive heart failure in sinus rhythm. To explore the incidence of interventricular desynchronizition in patients with chronic congestive heart failure,predictive factors of interventricular dyssynchrony, and the correlation between biventricular contractile desynchronization and left ventricular function. Methods Twenty-six patients with chronic congestive heart failure and 16 control subjects were studied by standard 12-lead electrocardiography,and gated equilibrium blood pool scintigraphy.Firstly,QRS duration, P-R duration were obtained by electrocardiography. Finally, these subjects were examined by radionuclide angioscintigraphy. Left ventricular ejection fraction, right ventricular ejection fraction and other functional parameters were obtained. Phase angles and full width half the maximal on phase histogram expressed interventricular contractile synchrony were computed in sinus rhythm. Results There were significant differences between ECGparameters (QRS duration, P-R duration), (117.64±33.16) ms vs (91.87±9.16) ms, (191.43±55.25) ms vs (161.75±22.17) ms (both P <0.05) ,phase angles of phase image analysis, (86.56±21.88)° vs (223. 81±101.41)°,(26.44±8.21)° vs (57.90±42.72)°(both P＜0. 01). In patients with heart failure,significantly negative correlation was found between phase angles and LVEF(r = -0. 709, P <0. 001). No correlation was found between phase angles and QRS duration. In patients with heart failure, 76.9% patients had interventricular contractile desynchrony. These patients also had lower left ventricular ejection fraction. In these patients, significantly negative correlation was found between phase angles and LVEF(r = -0. 55, P ,(0.05), what is more,no correlation was found between phase angles and QRS duration. Conclusion The patients with chronic heart failure have significantly abnormal electrocardiography,left ventricular systolic function, and parameters of phase image analysis. 76.9% patients with heart failure had interventricular contractile dyssynchrony who had lower left ventricular ejection fraction compared with patients without interventricular contractile dyssynchrony. A significant negative correlation is found between phase angles and LVEF. This study shows that interventricular contractile desynchronization may be one of causes decreasing left ventricular function.     

慢性心力衰竭患者心率振荡变化规律及预测价值

1999年由Schmidt等提出的心率振荡(HRT)是新近发现的一种与恶性心脏事件有密切关系的心电现象.     

心电图QRS波群时限和急性心力衰竭患者预后的相关性分析

目的 探讨心电图QRS波群时限和急性心力衰竭患者预后的相关性.方法 选取平顶山市第二人民医院2018年8月至2020年2月收治的92例急性心力衰竭患者的临床资料,按心电图QRS波群时限分为观察组(QRS<120 ms)与对照组(QRS≥120 ms),每组46例.比较两组心功能分级、给药情况、左心室射血分数(LVEF)...     

Prolonged paced QRS duration as a predictor for congestive heart failure in patients with right ventricular apical pacing

BACKGROUND: The recent studies showed that right ventricular (RV) pacing was associated with worsening of heart failure. The aim of this study is to clarify the clinical significance of paced QRS duration during RV pacing to predict congestive heart failure (CHF) patients. METHODS AND RESULTS: This study enrolled in 92 patients with atrioventricular block who underwent initial pacemaker implantation. The paced QRS duration was automatically obtained by electrocardiography immediately after pacemaker implantation and then by routine attendance at a pacemaker clinic every 3 months. The paced QRS duration was positively correlated with left ventricular end-diastolic dimension (P < 0.05) and left ventricular end-systolic dimension (P < 0.05), and tended to negatively correlate with left ventricular ejection fraction (P = 0.0507). The paced QRS duration immediately after pacemaker implantation was 170.4 +/- 18.9 ms. During a mean follow-up period of 53 +/- 16 months, 16 patients developed CHF. We selected as a cut-off value the nearest whole number (190 ms) that was one standard deviation greater than the mean, and divided into two groups according to baseline paced QRS duration. Patients with a paced QRS duration of <190 ms comprised group A (n = 77, nine of which developed CHF) and the remainder comprised group B (n = 15, seven of which developed CHF). Prolonged paced QRS duration (> or =190 ms) was associated with a significant increase in the overall morbidity of CHF (P < 0.05). Additionally, paced QRS duration significantly prolonged during the follow-up period among group A patients with CHF (P < 0.05), but did not change among patients without CHF. CONCLUSION: We concluded that paced QRS duration can be a useful indicator of impaired left ventricular function in patients with RV pacing. Even in patients whose paced QRS duration is relatively shorter, progressive prolongation of paced QRS duration can predict the development of CHF.     

慢性心力衰竭患者心脏失同步化与 QRS 时限及氨基末端前脑钠肽的相关性研究

目的 探讨 QRS 时限、氨基末端前脑钠肤(NT-proBNP)和心功能参数在判断心脏失同步的敏感性.方法 入选慢性心力衰竭(CHF)患者122例,经标准化药物治疗,NYHA 心功能Ⅲ～Ⅳ级,左心室射血分数(LVEF)≤35%.所有入选患者均行下列检查:①心电图检查;②检测NT-proBNP;③M 型超声心动图测量左心室舒张末内径(left ventricular end-diastolic diameter,LVEDD);④二维超声心动图测量LVEF;⑤彩色多普勒超声心动图测量QRS渡起始至肺动脉血流开始的时间(T1),QRS波起始至主动脉血流开始的时间T2,T2-T1>40 ms表示左、右心室间收缩失同步;⑥组织多普勒测量 QRS 波起始至左心室每一节段收缩期峰值速度时限即Ts,计算左心室12个节段达峰时间标准差(Ts-SD),Ts-SD>33 ms表示左心室内收缩不同步.心室失同步(ventricular desynchronization,VD)指T2-T1>40 ms和(或)Ts-SD>33 ms.根据QRS波时限将入选患者分为QRS≥120 ms组(A组)和QRS<120ms组(B组);根据是否存在VD,将A组分为A1亚组(VD组)和A2亚组(非VD组),B组分为B1亚组(VD组)和B2亚组(非VD组).结果 ①A组 VD 百分比率为75.0%,B 组 VD 百分比率为35.4%,两者差异有统计学意义(P<0.05);②A、B两组血浆NT-proBNP水平差异有统计学意义(P<0.01),而两组LVEDD和LVEF差异均无统计学意义(P>0.05);③QRS时限与NT-proBNP、LVEDD呈正相关(r=0.720、0.360,P<0.01或<0.05),与LVEF呈负相关(r=-0.320,P<0.01);④A1亚组和A2亚组、B1亚组和B2亚组、A1亚组和Bl亚组血浆NT-proBNP水平比较差异均有统计学意义(P<0.01),A2和B2两亚组血浆NT-proBNP比较差异无统计学意义(P>0.05).用LVEDD和LVEF做上述相同比较,差异均无统计学意叉(P>0.05).结论 ①QRS 波时限不是反映心室失同步的唯一指标,窄QRS波慢性心衰患者也存在心室失同步;②QRS渡时限与NT-proBNP水平有良好的相关性,二者结合可提高检测心室失同步的敏感性.     

用生活质量预测心力衰竭患者生存状况的研究

目的:探讨用生活质量预测心力衰竭患者生存状况的可行性。方法:采用问卷调查法,对入住北京市某三级医院208名心力衰竭患者进行住院时和出院后6个月的相关资料收集。结果:心力衰竭患者住院时和出院6个月时的平均生活质量得分分别为(50.00±25.30)分、(8.66±13.49)分,其中住院时的生活质量得分与患者6个月内的生存状况相关;Logistic回归分析显示,患者住院时生活质量得分、是否伴有心律失常是影响其死亡的主要风险因素。结论:患者住院时生活质量是影响心力衰竭患者死亡的主要危险因素之一,生活质量越差,预示心力衰竭患者未来死亡的可能性就越大,即用生活质量预测心力衰竭患者生存状况是可行的。     

T wave alternans as a risk predictor in patients with cardiomyopathy and mild-to-moderate heart failure

The analysis of t wave alternans (TWA) was introduced to identify patients with an increased risk of ventricular tachyarrhythmias. The inducibility of ventricular tachyarrhythmias and the spontaneous arrhythmic events are correlated with a positive TWA in patients with a reduced left ventricular ejection fraction and survived myocardial infarction. In contrast, this study is the first to investigate the correlation of a survived sudden cardiac death and TWA in patients without coronary heart disease and only slightly decreased left ventricular function. Sixty patients were included in the study. The TWA analysis was performed using the Cambridge Heart system (CH2000). Patients were sitting on a bicycle ergometer and exercised with a gradual increase of workload to maintain a heart rate of at least 105 beats/min. The exercise test was stopped after recording 254 consecutive low noise level heart beats. The electrocardiographic signals were digitally processed using a spectral analysis method. The magnitude of TWA was measured at a frequency of 0.5 cycles/beat. A TWA was defined as positive if the ratio between TWA and noise level was > 3.0 and the amplitude of the TWA was > 1.8 microV. Twelve (20%) of the included 60 patients showed a positive TWA. The sensitivity concerning a previous arrhythmic event amounted to 65%, the specificity up to 98%, respectively. The alternans ratio was significantly higher in patients with a previous event (30.3 +/- 53.2 vs 2.9 +/- 5.9, P < 0.001) and cumulative alternans voltage (4.67 +/- 3.55 vs 1.75 +/- 1.88 microV, P < 0.001). In 19 patients, invasively investigated by an electrophysiological study, a significant correlation between inducibility of tachyarrhythmias and a positive TWA result was found (Spearman R = 0.51, P = 0.01). In conclusion, the TWA analysis seems to identify patients with nonischemic cardiomyopathy who are at an increased risk of ventricular tachyarrhythmias.     

QRS duration and shortening to predict clinical response to cardiac resynchronization therapy in patients with end-stage heart failure

Despite current selection criteria (NYHA Class III-IV, LVEF < 35%, QRS > 120 ms with LBBB), 30% of patients do not benefit from cardiac resynchronization therapy (CRT). The use of QRS duration as selection criteria for CRT has not been evaluated systematically yet. Accordingly, the value of QRS duration at baseline (and reduction in QRS duration after CRT) to predict responders was studied. Patients were evaluated at baseline and after 6 months of CRT for NYHA Class, quality of life score, and 6-minute walk test. QRS duration was evaluated before, directly after implantation, and after 6 months of CRT. Sixty-one patients were included; 45 (74%) patients were classified as responders (improvement of NYHA Class, 6-minute walking distance and quality of life score) and 16 (26%) as nonresponders. QRS duration at baseline was similar between the two groups: 179 +/- 30 ms versus 171 +/- 32 ms, NS. Directly after implantation, QRS duration was reduced from 179 +/- 30 ms to 150 +/- 26 ms (P < 0.01) in responders; nonresponders did not exhibit this reduction (171 +/- 32 ms vs 160 +/- 26 ms, NS). After 6 months of CRT, QRS shortening was only observed in responders (from 179 +/- 30 ms to 159 +/- 25 ms, P < 0.01). ROC curve analysis showed that a reduction in QRS duration > 10 ms had a high sensitivity (73%) with low specificity (44%); conversely, a > 50 ms reduction in QRS duration was highly specific (88%) but not sensitive (18%) to predict response to CRT. No optimal cutoff value could be defined. QRS duration at baseline is not predictive for response to CRT; responders exhibit a significant reduction in QRS duration after CRT, but individual response varies highly, not allowing adequate selection of responders.     

碎裂QRS波对扩张型心肌病患者预后的预测价值

目的:探讨碎裂QRS波(f QRS)对扩张型心肌病(DCM)患者预后的预测价值。方法:对166例DCM患者和100例健康对照者进行12导联心电图检查,根据患者是否存在f QRS分为f QRS组和无f QRS组,比较f QRS在DCM组和健康对照组的发生率,比较DCM患者中f QRS组和无f QRS组心血管事件的发生率,并进行多变量Cox回归分析。结果:DCM组f QRS发生率显著高于对照组(P<0.01);DCM患者中f QRS组心源性猝死、非猝死性心性死亡、恶性心律失常、左室射血分数(LVEF)降低和严重房室传导阻滞发生率显著高于无f QRS组(P<0.01~0.001);多变量Cox回归分析显示:f QRS对DCM的影响有显著统计学意义(P<0.01)。结论:f QRS可成为心电图诊断DCM的新指标,是DCM患者心血管事件的预测因子。     

Electrocardiographic left ventricular hypertrophy Cornell product is a feasible predictor of cardiac prognosis in patients with chronic heart failure

Background

Left ventricular hypertrophy (LVH) is an independent risk factor for cardiovascular disease and is associated with heart failure development. The Cornell product is an easily measured electrocardiographic parameter for assessing LVH. However, it is undetermined whether the Cornell product can predict the cardiac prognosis of chronic heart failure (CHF) patients.

Methods and results

We performed standard 12-lead electrocardiography and calculated the Cornell product in 432 consecutive CHF patients. LV geometry was assessed as normal, concentric remodeling, concentric or eccentric hypertrophy. The Cornell product was significantly higher in patients with eccentric hypertrophy, and increased with advancing New York Heart Association functional class. During a median follow-up of 660 days, there were 121 cardiac events including 36 cardiac deaths and 85 re-hospitalizations for worsening heart failure. Multivariate Cox proportional hazard analysis showed that the Cornell product was an independent predictor of cardiac events in CHF patients. Patients in the highest quartile of Cornell product had a higher prevalence of LV eccentric hypertrophy (22, 29, 33 and 67 % for quartiles one through four). Kaplan–Meier analysis demonstrated that the highest quartile of Cornell product was associated with the greatest risk among CHF patients.

Conclusion

The Cornell product is associated with LV eccentric hypertrophy and can be used to predict future cardiac events in CHF patients.