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目的:通过分析平面QRS-T夹角与急性心力衰竭综合征(acute heart failure syndromes,AHFS)近、远期不良结局相关性评价其预后预测价值。方法:2所中心医院125例AHFS患者,根据入院首次心电图平面QRS-T夹角将患者分为<90°组和≥90°组。采集患者入院首次病史、体征、辅助检查等基线变量,比较两组患者基线参数差异。随访入院至出院后30d(近期)和1年(远期)不良结局发生情况,Kaplan-Meier(K-M)生存分析进行2组近、远期不良预后发生率差异比较,Cox回归模型多因素分析平面QRS-T夹角≥90°与不良预后关系。结果:所有患者平均平面QRS-T夹角为(116.5±46.9)°。≥90°组96例患者中远期不良结局92例,其中50例为近期不良结局患者。<90°组29例患者中远期不良结局19例,其中8例为近期不良结局患者。与<90°组患者相比,≥90°组心影增大、V1导联终末电势(PtfV1)≤-0.04 mm·s更多见,并且有更低的肾小球滤过率估计值(eGFR)和左室射血分数(LVEF)、更高的CK-MB和肌钙蛋白I。K-M曲线:两组近、远期不良结局发生率曲线差别均有统计学意义。经PtfV1≤-0.04mm·s、心影增大、eGFR、LVEF、CK-MB和肌钙蛋白I多因素校正后平面QRS-T夹角≥90°与近期不良结局发生率相关性无统计学意义(HR:1.78,95%CI:0.75~4.22,P=0.19),但仍是远期不良预后的独立预测因素(HR:2.04,95%CI:1.18~3.56,P=0.01)。结论:平面QRS-T夹角≥90°是本研究AHFS队列远期不良预后的独立预测因素,尚不能认为是近期不良预后的预测因素。
OBJECTIVE: To evaluate the predictive value of QRS-T between the QRS-T angle and acute heart failure syndromes (AHFS). Methods: A total of 125 AHFS patients from two central hospitals were divided into two groups according to the angle of QRS-T at the first electrocardiogram admission. Baseline variables such as first medical history, signs and auxiliary examinations were collected and baseline parameters were compared between the two groups. The incidences of adverse outcomes at 30 days (short-term) and 1-year (long-term) after admission to hospital were followed up. Kaplan-Meier (KM) survival analysis was performed to compare the incidence of poor prognosis between the two groups. Cox regression model multivariate analysis QRS-T angle ≥ 90 ° with poor prognosis. Results: The mean plane QRS-T angle of all patients was (116.5 ± 46.9) °. In the group of ≥90 °, 96 patients had long-term adverse outcomes of 92 cases, of which 50 were patients with recent adverse outcomes. Ninety-nine patients in the <90 ° group had long-term and poor-term outcomes, of which, eight were late-stage unfavorable outcomes. Compared with patients in the <90 ° group, the ≥90 ° group had increased cardiac output, the V1 lead terminal potential (PtfV1) ≤ -0.04 mm · s was more common and had a lower glomerular filtration rate estimate (eGFR) and left ventricular ejection fraction (LVEF), higher CK-MB and troponin I. K-M curve: two groups of near and long-term adverse outcome rate curve was statistically significant. The PtfV1≤-0.04mm · s, the heart shadow increased, eGFR, LVEF, CK-MB and troponin I multiplane correction of planar QRS-T angle ≥ 90 ° and the incidence of adverse outcomes no significant correlation (HR: 1.78, 95% CI: 0.75-4.22, P = 0.19), but it was still an independent predictor of long-term adverse prognosis (HR: 2.04, 95% CI: 1.18-3.56, P = 0.01). CONCLUSIONS: The plane QRS-T included angle ≥90 ° is an independent predictor of poor long-term prognosis of AHFS cohort in this study and can not be considered as a predictor of recent adverse prognosis.