QRS时限与缺血性心肌病预后关系

目的观察缺血性心肌病患者QRS时限与远期预后相关性方法入选2006年1月至2009年12月于我院导管室进行冠状动脉造影,经左室造影证实LVEF≤35%,出院诊断明确的缺血性心肌病患者。按照患者的心电图记录的QRS波时限将所有患者分为2组,分别为QRS时限120ms组,QRS时限≥120ms组。比较两组患者的基线临床特征,远期预后。影响全因死亡、心脏移植、室性心律失常事件、心衰再入院的危险因素。结果缺血性心肌病患者921例,5例患者失访,916例患者完成研究。入选患者中QRS时限120ms患者835例(91.2%),QRS时限≥120ms患者81例(8.8%)。与QRS时限120ms组比较,QRS时限≥120ms患者,左室舒张末期内径明显增加;心功能分级有所减低;房颤病史更为常见。916例患者随访9-58月,49例(5.3%)患者发生全因死亡;发生全因死亡、新发生的血流动力学改变的室性心律失常、心衰再入院,心脏移植事件总计96例(10.5%)。Cox回归分析显示:超声心动图射血分数≤35%,QRS时限≥120ms,完全性左束支传导阻滞是缺血性心肌病发生全因死亡、心衰再入院、室性心律失常、心脏移植复合终点事件的危险因素。结论冠状动脉造影证实的LVEF≤35%缺血性心肌病患者,QRS时限≥120ms是影响患者全因死亡、心衰再入院、室性心律失常、进行心脏移植事件的高危因素。

The relationship between QRS width and the Prognosis of Ischemic Cardiomyopathy

Objective This retrospective cohort study is designed to analysis the relationship between QRS width and ischemia cardiomyopathy. Methods The consequentive in-patients with definite diagnosis of ischemia cardiomyopathy from Jan 2006 to Dec 2009. All of the patients were divided into two groups of QRS 120ms, and QRS ≥120ms group. The clinic characteristics, the prognosis of ischemia cardiomyopathy between two group patients were contrasted. Results We studied 921 patients, 5 patients were lost and 916 patients completed the study. During the follow-up of 9-58 months, 49 patients（5.3%） were death.Cox regression was performed the risk factors of all cause death, ventricular arrhythmia, heart failure in hospital, heart transplantation included： left ventricular eject fraction is less than 30% in echocardiography, the width of QRS≥120ms, and with left bundle branch block. Conclusion For the patients definite diagnosis of ischemia cardiomyopathy, the width of QRS ≥120ms is the risk factor of all cause death, heart failure in hospital, ventricular arrhythmia and heart transplantation.