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目的:心电图QT间期离散度对心血管事件的预测价值仍有争议,实验从向量图的角度探讨QT间期离散度的应用及其对心力衰竭患者预后的预测价值。方法:①临床资料:2003-05/2005-07在桂林医学院附属医院住院的充血性心力衰竭患者229例为充血性心力衰竭组,年龄60～83岁;同期住院的急性冠脉综合征患者26例为急性冠脉综合征组;30例年龄匹配的正常人为正常对照组。所有受试者对实验均知情同意,实验符合伦理学标准。②检测方法:使用北京美高仪软件技术有限公司提供的Q/CPCGY 001-2000型心电综合分析系统检测向量图;同时检测与向量图同步记录的12导联心电图;应用上海群天医疗器械有限公司生产的Q/NYOZ-02-2001型动态心电图仪检测室性心律失常的发生情况;对充血性心力衰竭患者电话随访2年,只询问健在还是死亡。③观察指标:向量图各指标与QT间期离散度的关系、二者与心律失常事件和死亡率的关系。结果:285例受试者的资料均进入结果分析。①向量图指标:充血性心力衰竭组及急性冠脉综合征组额面及横面的QRS/T夹角均大于正常对照组(P<0.05);死亡组额面及横面的QRS/T夹角均显著大于生存组(P<0.05);室性早搏≥LOWNⅢ级者的额面及横面QRS/T夹角的平均角度均显著大于<Ⅲ级者(P<0.05～0.01)。②心电图指标:充血性心力衰竭组及急性冠脉综合征组QTc、间期离散度均大于正常对照组(P<0.05);死亡者的QTc显著大于生存者(P<0.01);室性早搏≥LOWNⅢ级QT者的QTc显著大于<Ⅲ级者(P<0.05)。③相关性分析:额面及横面的QRS/T环的夹角与QT间期离散度呈显著正相关(P<0.05)。结论:向量图的QRS/T夹角、心电图的QTc是反映心肌电不稳定、预测充血性心力衰竭患者心律失常事件、死亡率、以及长期预后不良的有用指标,QT间期离散度无预测作用。
OBJECTIVE: The predictive value of ECG QT dispersion on cardiovascular events is still controversial. The application of QT dispersion and its prognostic value in patients with heart failure are discussed in terms of vector graphs. Methods: ①Clinical data: From May 2003 to July 2005, 229 hospitalized patients with congestive heart failure in the Affiliated Hospital of Guilin Medical College were congestive heart failure patients, aged 60-83 years. Patients with acute coronary syndrome 26 cases of acute coronary syndrome group; 30 age-matched normal control group. All subjects were informed consent of the experiment, the experiment meets the ethical standards. ②Detection method: use the Q / CPCGY 001-2000 type ECG comprehensive analysis system provided by Beijing Meigao Software Technology Co., Ltd. to test the vector diagram; at the same time detect the 12-lead electrocardiogram recorded synchronously with the vector diagram; and apply Shanghai Quntian Medical Instrument Co., Ltd. produced Q / NYOZ-02-2001-type Holter monitor ventricular arrhythmias; congestive heart failure patients were followed up for 2 years, only asked whether alive or dead. Â ’¢ observation index: the relationship between the various indicators of vector diagram and QT dispersion, the relationship between the two and arrhythmia events and mortality. Results: The data of 285 subjects entered the result analysis. (1) Vector diagram index: The QRS / T angles of frontal and transverse planes of congestive heart failure group and acute coronary syndrome group were both larger than that of normal control group (P <0.05); QRS / T (P <0.05). The average angles of frontal and lateral QRS / T angles in patients with LVEF≥LOWN Ⅲ were significantly greater than those in <Ⅲ grade (P <0.05-0.01). (2) Electrocardiographic parameters: QTc and interval dispersion of congestive heart failure group and acute coronary syndrome group were significantly higher than those of normal control group (P <0.05); QTc of deceased persons was significantly higher than that of survivors (P <0.01) The QTc of ≥LOWN grade QT was significantly higher than that of grade Ⅲ (P <0.05). Correlation analysis: There was a significant positive correlation between the QRS / T ring angle and the QT interval dispersion (P <0.05). Conclusion: QRS / T angle and QTc of electrocardiogram are useful indicators to reflect cardiac electrical instability, predict arrhythmia events, mortality and long-term prognosis of patients with congestive heart failure. QT interval dispersion has no predictive value .