The inf1uences of QRS comp1ex duration in patients with chronic 1eft heart fai1ure
10.3969/j.issn.1004-8812.2016.03.007
- VernacularTitle:心电图QRS波时限对慢性左心衰竭患者短期预后的影响
- Author:
Yonghui LI
;
Fangfang FAN
;
Tao HONG
- Publication Type:Journal Article
- Keywords:
Electrocardiography;
QRS complex duration;
Chronic left heart failure;
Prognosis;
Risk factors
- From:
Chinese Journal of Interventional Cardiology
2016;24(3):154-159
- CountryChina
- Language:Chinese
-
Abstract:
Objective To study the effects of QRS-complex duration of patients with chronic left heart failure on their in-hospital prognosis. Methods Total 174 patients admitted for chronic left heart failure ( New York Heart Association class 3 and 4 ) from January 2014 to June 2015 were enrolled the study. They were divided into two groups according to the QRS duration at admission:normal QRS duration group (QRS ≤120 ms, n=145) and prolonged QRS group (QRS ﹥120 ms, n=29). The differences of clinical characteristics and incidences of exacerbated left heart failure, fatal arrhythmias and cardiac death during hospitalization were compared between the two groups. The influences of QRS duration on in-hospital adverse cardiovascular events was analyzed by logistic regression. Resu1ts The proportion of males (75. 9% vs. 24. 1%, P=0. 001), plasma B-type natriuretic peptide (BNP) (7. 1 ± 0. 8 vs. 6. 6 ± 1. 0, P=0. 02), left ventricular end diastolic diameter (LVEDd) [(60. 7 ± 9. 9)mm vs. (53. 5 ± 10. 8)mm, P=0.001], left ventricular end systolic diameter (LVESd) [(49.1 ±13.3)mm vs. (39.7 ±13.0)mm, P﹤0. 001], and the incidence of exacerbated left heart failure (20. 7% vs. 4. 8%, P = 0. 003), fatal arrhythmias (55. 2% vs. 21. 4%, P ﹤0. 001) and cardiac death (6. 9% vs. 0. 7%, P =0. 019) during hospitalization were significantly higher in the prolonged QRS group than in the normal QRS group. Left ventricular ejection fraction( LVEF) in the prolonged QRS group was significantly lower than in the normal QRS group (39. 6% ±17. 3% vs. 50. 5% ± 17. 3%, P =0. 002). Heart rates [(92. 4 ± 21. 4)bpm vs. (81. 6 ± 19. 9)bpm,P=0. 035], plasma BNP(7. 2 ± 0. 8 vs. 6. 7 ± 1. 0, P=0. 029), LVEDd(63. 5 ± 9. 1 vs. 57. 9 ± 9. 1, P=0. 015), LVESd (52. 9 ± 12. 2 vs. 44. 3 ± 11. 8, P=0. 005), incidences of left heart failure deterioration (18. 2% vs. 3. 2%, P=0. 018), fatal arrhythmias (63. 6% vs. 36. 5%, P=0. 027) and cardiac death ( 9. 1% vs. 0%, P=0. 015 ) during hospitalization among male patients in the prolonged QRS group were significantly higher than those in the normal QRS group, but LVEF ( 35. 0% ± 15. 3%vs. 47. 1% ± 16. 2%, P =0. 003 ) was on the opposite. The incidence of left heart failure deterioration among female patients in the prolonged QRS group was higher than that in the normal QRS group ( 28. 6%vs. 6. 1%, P=0. 034). QRS complex duration was positively related to LVEDd ( r=0. 4019, P﹤0. 001) and LVESd ( r =0. 3289, P ﹤0. 001 ) . LVEF in male patients was significantly lower than in female patients (40. 0% ± 16. 7% vs. 53. 2% ± 17. 6%, P﹤0. 001). On the contrary, LVEDd [(59. 4 ± 9. 4) mmvs. (50.3±10.6)mm,P﹤0.001],LVESd[(46.6±12.5)mmvs. (36.2±12.4)mm,P﹤0.001] were greater in male patients than in female patients. After adjusting for gender , age, cigarette smoking, history of high blood pressure, serum creatinine, low-density lipoprotein cholesterol, LVEF, LVEDd, LVESd, use of angiotensin converting enzyme inhibitors ( ACEI) or angiotensin receptor blockers ( ARB) and aldosterone receptor blockers, multiple logistic regression analysis showed that prolonged QRS complex duration is an independent risk factor of adverse prognosis for the patients with HF during hospitalization (OR=4. 21,95%CI:1. 59-11. 12,P=0. 004), and female gender is a protective factor for them ( OR=0. 304,95%CI:0. 116-0. 793,P=0. 015). Conc1usions The incidences of left heart failure deterioration, fatal arrhythmias and cardiac death in the chronic left heart failure patients with prolonged QRS duration were higher than in those with normal duration. Female gender is a protective factor for chronic left heart failure.
