老年心力衰竭患者心电图校正QT间期改变及相关因素分析

Change of corrected QT interval in electrocardiogram and associated risk factors for its prolongation in elderly patients with heart failure

摘要:

目的 探讨老年心力衰竭患者心电图校正的QT间期(QTc)变化及其延长的相关因素。方法 选取2018年1月至2021年1月于无锡市惠山区第二人民医院收治的左心功能不全,但窦性心律、无明确的束支传导阻滞532例患者的临床资料。所有患者治疗前均完成心功能评估及心电图和心脏超声检查。按QTc≥440ms和QTc＜440ms分组,按纽约心脏病学会(NYHA)心功能分级,年龄,左室射血分数(LVEF),左室舒张末内径(LVEDd),脂蛋白磷脂酶A₂(Lp-PLA₂),氨基末端脑钠肽前体(NT-proBNP),合并高血压、糖尿病、冠心病、其他心脏相关性疾病等两种及以上疾病分类统计,分析老年心力衰竭患者QTc变化及其延长的相关危险因素。采用SPSS 21.0软件进行数据分析。根据数据类型,组间比较分别采用t检验、χ²检验及方差分析,二分类多因素logistic回归分析QTc延长的相关危险因素。结果 NYHA心功能Ⅰ～Ⅳ级老年患者分别为71、130、245、86例,QTc依次为:(415.34±22.80)、(423.72±38.95)、(433.45±37.33)和(465.74±37.69) ms,组间差异均有统计学意义(均P＜0.05)。所有患者QTc均值(433.69±39.35) ms,其中,QTc≥440ms组患者207例,QTc (472.63±31.40)ms；QTc＜440ms组患者325例,QTc (408.89±18.02) ms。QTc≥440ms组和QTc＜440ms组相关因素比较,年龄[ (78.32±7.55) 和 (75.03±8.07)岁], LVEDd [ (51.89±9.77) 和 (48.95±8.69)mm], LVEF[(48.01±9.98)% 和 (56.75±8.50)%], Lg(NT-proBNP) [(3.33±0.74) 和 (3.03±0.68)],差异均有统计学意义(均P＜0.05)；Ln(Lp-PLA₂)[(4.87±0.65)和(4.79±0.84 )],差异无统计学意义(P＞0.05)。二分类多因素logistic回归分析显示,LVEDd、LVEF、NT-proBNP及合并两种及以上疾病为QTc延长的危险因素。结论 老年心力衰竭患者QTc延长与心功能不全的严重程度相关,心脏相关性疾病及心脏结构改变是其延长的危险因素。

Abstract:

Objective To investigate the change of corrected QT interval (QTc) of electrocardiogram (ECG) and associated risk factors of its prolongation in the elderly patients with heart failure. Methods A total of 532 old patients with left cardiac insufficiency, who had a sinus rhythm and no clear bundle branch block, were enrolled in the study in Wuxi Huishan District No.2 People′s Hospital from January 2018 to January 2021. All patients had received cardiac function assessment, ECG, and cardiac ultrasound examination ebefore the treatment. They were divided into QTc≥440 ms group and QTc＜440 ms group. Analyses were made of the changes of QTc and the risk factors of its prolongation in elderly patients with heart failure in relation to classification of New York Heart Association (NYHA), age, left ventricular ejection fraction(LVEF), left ventricular end-diastolic diameter (LVEDd), lipoprotein phospholipase A2 (Lp-PLA₂), amino-terminal brain natriuretic peptide (NT-proBNP), comorbidities of two or more diseases such as hypertension, diabetes mellitus, coronary heart disease and other heart-related diseases. SPSS statistics 21.0 was used for statistical analysis. Depending on data type, comparison between two groups was performed using t-test, χ² test or Fisher exact test. Logistic regression analysis was used to determine the risk factors of the prolonged ECG QTc. Results The patients fell into NYHA Class I-IV were 71,130, 245, and 86, and the means of QTc in the four class groups was (415.34±22.80), (423.72±38.95), (433.45±37.33) and (465.74±37.69)ms respectively (P <0.05). The mean QTc was (433.69±39.35)ms, with 207 patients in the QTc≥440 ms group [mean=(472.63±31.40) ms] and 325 in the QTc<440 ms group [mean= (408.89±18.02) ms]. The difference between the two groups was significant in age [(78.32±7.55) vs (75.03±8.07) years], LVEDd [(51.89±9.77) vs (48.95±8.69) mm], LVEF[(48.01±9.98)% vs (56.75±8.50)%], Lg(NT-proBNP) [(3.33±0.74) vs (3.03±0.68)], but not significant in ln(Lp-PLA₂)[(4.87±0.65) vs (4.79±0.84), P>0.05]. Logistic regression analysis showed that the LVEDD, LVEF, NT-proBNP and comorbidities of two or more heart-related diseases were the risk factors for QTc prolongation. Conclusion The prolonged ECG QTc in elderly patients with heart failure is correlated with cardiac insufficiency, and heart-related diseases and cardiac structural change are the risk factors.