术前心电图表现预测慢性心衰患者心脏再同步化治疗效果的临床价值

目的 探讨术前心电图表现对慢性心衰（Chronic heart failure，CHF）患者心脏再同步化治疗（Cardiac resynchronization therapy，CRT）疗效的预测价值。方法 纳入我院2015年10月～2017年10月收治的慢性心衰患者80例，所有患者均接受CRT治疗，根据治疗效果分成有效组、无效组。其中有效指术后6个月患者心功能（NYHA分级）改善≥1级，或超声心动图提示左室收缩末容积（end-systolic volume，ESV）下降>15%，或左室射血分数（Left ventricular ejection fraction，LVEF）绝对值上升>5%，未达上述标准及死亡均视为无效。所有纳入者均在术前接受心电图检查，比较两组临床特征，包括性别、年龄、病程、体质指数、基础病因、心功能分级、房颤、高血压、冠脉问题、糖尿病、术前心电图指标（心率、Tp-Te间期、QRS波时限）。通过绘制ROC曲线模型分析术前心电图指标对CRT治疗无效的预测价值，采用Logistic回归性分析明确CRT治疗无效的独立危险因素。结果 在术后6个月，有23例CHF患者CRT治疗无效，占28.75%，57例有效，占71.25%。无效组病程≥3年、NYHAⅣ级、有房颤、有冠脉问题占比分别为78.26%、47.83%、52.17%、47.83%，较有效组的49.12%、10.53%、12.28%、10.53%更高，且无效组心率、Tp-Te间期、QRS波时限均高于有效组，差异有统计学意义（P<0.05）。经ROC曲线模型提示心率、Tp-Te间期、QRS波时限预测CHF患者CRT治疗无效的曲线下面积分别为0.710、0.764、0.742。经Logistic回归性分析提示病程、NYHA分级、房颤、冠脉问题以及心率、Tp-Te间期、QRS波时限是CHF患者CRT治疗无效的独立危险因素（P<0.05）。结论 术前心电图检查能明确CHF患者心率、Tp-Te间期以及QRS波时限，三者对CRT治疗效果具有一定预测价值，且均为CRT无效的危险因素。

Clinical value of preoperative electrocardiogram in predicting cardiac resynchronization therapy in patients with chronic heart failure

Objective To explore the predictive value of preoperative electrocardiogram (ECG) for cardiac resynchronization in patients with chronic heart failure.Methods 80 patients with chronic heart failure admitted to our hospital from October 2015 to October 2017 were included.All patients received CRT treatment.According to the treatment effect, the patients were divided into effective group and invalid group.Effective refers to the improvement of cardiac function (NYHA grade) in patients 6 or 1 months after operation.Or echocardiography showed that the end-systolic volume (ESV) decreased by >15%.The absolute value of the left ventricular ejection fraction (LVEF) increased by >5%.Failure to reach the above criteria and death are considered null and void.All the patients underwent electrocardiogram before operation, and the clinical characteristics of the two groups were compared.Including sex, age, course of disease, body mass index, basic cause of disease, classification of heart function, atrial fibrillation, hypertension, coronary problem, diabetes, preoperative electrocardiogram index (heart rate, Tp-Te interval, QRS wave time).The predictive value of preoperative electrocardiogram (ECG) indicators for CRT treatment failure was analyzed by drawing ROC curve model.Logistic regression analysis was used to identify the independent risk factors of CRT failure.Results In 6 months after operation, 23 cases of CHF patients failed to receive CRT treatment, accounting for 28.75%, and 57 cases were effective, accounting for 71.25%.In the ineffective group, the course of disease was more than 3 years, NYHA IV, atrial fibrillation and coronary problems were 78.26%, 47.83%, 52.17%, 47.83% respectively, compared with 49.12%, 10.53%, 12.28% and 10.53% of the effective group.The heart rate, Tp-Te interval and QRS wave duration of the invalid group were all higher than those of the effective group.The difference was statistically significant (P<0.05).The ROC curve model indicated that the heart rate, Tp-Te interval and QRS wave duration predicted that the area under the curve of CRT treatment for CHF patients was 0.710, 0.764 and 0.742 respectively.Logistic regression analysis showed that the course of disease, NYHA classification, atrial fibrillation, coronary problems and heart rate, Tp-Te interval, and QRS wave time were independent risk factors for CRT treatment in CHF patients (P<0.05).Conclusion Preoperative electrocardiogram examination can clearly define the heart rate, Tp-Te interval and QRS wave duration of CHF patients.The three had predictive value for CRT treatment and were all risk factors for CRT failure.