心力衰竭加重并左室射血分数降低患者的QRS时限与预后

目的观察住院期间QRs时限对心力衰竭并左室射血分数降低预后的影响。方法回顾性分析心力衰竭并左室射血分数降低（≤40％）或正常的住院患者住院期间的QRs波群时限。结果3002例患者纳入研究，其中正常QRS波群时限1745例（〈120ms），QRS波群延长（≥120ms）1257例。平均随访10个月，基础QRS波群时限正常患者全因死亡率为18．8％，基础QRS波群延长患者为28．3％（nR。1．62，95％CIL38～1．88）。基础QRS波群正常患者心血管死亡和心力衰竭住院率为31．5％和35．8％，延长者则为39．0％和43．6％（朋=1．40、1．42；95％CIL25-1．60、1．18-1．72）。QRS波群时限延长与增加全因死亡率危险性相关（HR=1．25：95％C11．03～1．52），并增加心血管死亡或心力衰竭住院率（HR=1．21、1．28，95％CIL10～1．40、1．12～1．38）。基础Qas波群延长患者最后住院心电图QRS波群正常者仅为4．0％。结论延长的QRS波群在LVEF降低患者中十分多见，是出院后高患病率和高死亡率的独立预测因素。

The prognostic value of QRS duration in heart failure patients with reduced ejection fraction

Objective To observe the influence of QRS duration on the prognosis of heart failure patients with reduced left ventricular ejection fraction. Methods A retrospective analysis of inhospital patients with heart failure and reduced （≤40%） or normal left ventricular ejection fraction was done to analyze the QRS wave dura- tion. Results The 3002 patients included in the study included 1745 cases with normal QRS wave duration（〈120 ms） and 1257 eases with prolonged QRS wave（ ≥ 120 ms）. The mean follow-up time was 10 months, patients with normal QRS duration showed a all-cause mortality of 18.8% and those with prolonged QRS wave had a mortality of 28.3% （HR= 1.62, 95%C1 1.38-1.88）. Cardiovascular death or heart failure hospitalization of patients with normal and prolonged QRS wave groups were 31.5%, 35.8% vs 39.0%, 43.6% （HR=1.40, 1.42; 95%CI 1.25-1.60, 1.18- 1.72） respectively. QRS duration prolongation correlated with increased all-cause mortality （HR =1.25; 95% CI 1.03-1.52） and cardiovascular death or heart failure hospitalization （HR=1.21, 1.28, 95%CI 1.10-1.40, 1.12- 1.38 ）. At the last hospitalization time the normal QRS wave was 4% in wide QRS group. Conclusion QRS pro- longation in patients with reduced LVEF is an independent predictor of morbility and mortality.