QRS时限对急性心肌梗死后心功能不全的诊断及预测价值

目的探讨急性心肌梗死(acute myocardial infarction,AMI)后QRS时限变化对AMI后近期心功能不全的预测价值,并与脑型利钠肽(BNP)进行比较。方法入选120例初发AMI患者,72h内记录患者心功能Killip分级等项目,按照Killip分级1、2、3、4将患者分为4组,均检测血浆BNP 浓度、常规心电图测定QRS时限。所有患者观察随访6周,6周时行超声心动图检查测定左室射血分数(LVEF),按照LVEF分为心衰组和正常组。结果QRS时限及BNP浓度在Killip分级1、2、3、4级各组中阶次升高,各组之间差异有统计学意义(P＜0.01);BNP浓度、QRS时限与AMI后急性期心功能Killip分级呈正相关(r分别为0.556,0.385);心衰组BNP、QRS时限均显著高于对照组(P＜0.01);急性期BNP浓度、QRS时限与恢复期LVEF呈负相关(r分别为-0.577,-0.502);AMI后急性期BNP＞596pg／mL及QRS时限＞100ms是近期心衰的独立预测因素(BNP：OR=13.512,P=0.009;QRS时限:OR=4.696,P=0.055);QRS时限与BNP显著相关(r=0.752)。结论QRS时限可用于AMI后心功能不全的早期诊断及危险性评价,临床应用价值与BNP相似。

The QRS interval for cardiac insufficiency following acute myocardial infarction

To explore the role of the QRS interval for cardiac insufficiency in the immediate future following acute myocardial infarction (AMI). Methods120 patients with AMI for the first time were enrolled in the study and divided into four groups based on the heart function classification of Killip recorded within 72 hours after hospitalization. The density of brain natriuretic peptide (BNP) was determined in the plasma and the QRS interval was determined by electrocardiography. All patients were reviewed and followed up for 6 weeks and at the 6th week, the LVEF was determined by echocardiography. ResultThe QRS interval and level of BNP were increased by turns based on the heart function classified by Killip grade 1-4 and the differences were significant in each group(P＜0.01). The heart function classification of Killip in the acute stage following AMI positively correlated with the BNP and QRS interval(r=0.556 and r=0.385).　The log BNP and QRS interval were significantly higher in patients with heart failure than those in the control group(P＜0.01). LVEF of the recovery phase negatively correlated with the BNP and QRS interval(r=-0.577 and r=-0.502). The BNP＞596pg／mL and QRS interval＞100ms in the acute phase were both independent prognostic factors of heart failure in the immediate future following AMI(BNP OR=13.512, P=0.009;　QRS interval OR=4.696,　P=0.055).