杨洁，侯翠红，刘周英，任岚，孙兴国，浦介麟



心电图异常对预测扩张型心肌病致慢性心力衰竭患者的预后意义

杨洁，侯翠红，刘周英，任岚，孙兴国，浦介麟

摘要

关键词心肌病，扩张型；心力衰竭；心电描记术；预测

作者单位：100037 北京市，北京协和医学院 中国医学科学院 国家心血管病中心 阜外医院 功能检测中心

Predictive Value of Electrocardiogram Abnormality on Prognosis of Chronic Heart Failure in Patients With Dilated Cardiomyopathy

YANG Jie,HOU Cui-hong,LIU Zhou-ying,REN Lan,SUN Xing-gou,PU Jie-lin.
Function Testing Center,Cardiovascular Institute and Fu Wai Hospital,CAMS and PUMC,Beijing(100037),China
Co-corresponding Authors:SUN Xing-gou,Email:xgsun@labiomed.org and PU Jie-lin,Email:jielinpu@yahoo.com

Abstract

Objective:To study the predictive value of 12-lead electrocardiogram(ECG)abnormality on prognosis of chronic heart failure in patients with dilated cardiomyopathy(DCM-CHF).

Methods:A prospective,multicenter follow-up study in 787 DCM-CHF patients was conducted,and the endpoints were obtained by clinical visit,mail contact and telephone conversation.The independent predictors for all cause death were determined by Cox regression analysis,QRS duration >120 ms was studied and the survival rates were investigated by Kaplan-Meier analysis.

Results:There were 203 patients died during the follow-up period.Cox regression analysis found that the following indexes were related to all cause death:atrial fibrillation(AF)(HR=2.064,95% CI 1.102-3.864,P<0.05),non-sustained ventricular tachycardia(NSVT)(HR=3.887,95% CI 1.554-9.724,P<0.05)and QRS duration(HR=1.010,95% CI 1.002-1.018,P<0.05).Kaplan-Meier analysis revealed that the survival rates were different by each stratification of QRS duration,P<0.05.

Conclusion:ECG indexes of AF,NSVT and QRS duration had the important impact on the survival rate in DCM-CHF patients;there were significant differences between QRS durations and survival rates.

Key words Cardiomyopathy,dilated;Heart failure;Electrocardiography;Prediction(Chinese Circulation Journal,2016,31:218.)

扩张型心肌病（Dilated Cardiomyopathy,DCM）是临床上最常见的心肌病,是心肌的原发性疾病，以左心室或双心室扩张和收缩功能下降为特征。DCM患者收缩功能受损，是导致慢性心力衰竭（心衰）最常见的原因，并呈逐年上升趋势。其严重后果是并发致命性心律失常和心原性猝死。尽管临床治疗不断改进，DCM的病死率仍然很高。以往报道多种方法可以用于慢性心衰患者猝死的预测，包括峰值氧摄取率、左心室射血分数、信号叠加心电图和心内电生理检查等。心电图被美国心脏病学会和欧洲心脏病学会推荐为心衰患者的初始检查。确实，大多数慢性心衰患者由于心脏收缩功能障碍其心电图出现显著异常。从心电图得出预后是很有价值的，因为12导联心电图是世界范围内广泛应用的检查，其价格便宜、操作简单、结果客观、重复性好。

1　资料与方法

研究对象：本研究采用前瞻性方法，随访了自2005-07至2009-12就诊于阜外医院、北京大学人民医院、南京医科大学第一附属医院等13家合作医院的787例DCM致慢性心衰患者,随访至2011年底，分为全因死亡组（n=203）和存活组（n=584）。选择标准包括：由DCM引起的；经系统的抗心衰药物治疗后，据纽约心脏协会（NYHA）心功能分级仍为Ⅱ～Ⅳ级的慢性心衰患者；左……