Prognostic value and temporal behavior of the planar QRS-T angle in patients with nonischemic cardiomyopathy
Prognostic value and temporal behavior of the planar QRS-T angle in patients with nonischemic cardiomyopathy
复制标题
DOI：
10.1161/circulationaha.107.733451
复制
发表时间：
2008-06-24
期刊：
影响因子：
37.8
通讯作者：
Kadish, Alan
中科院分区：
文献类型：
--
作者：
Pavri, Behzad B.;Hillis, Matthew B.;Kadish, Alan
背景-平面QRS-T角可以很容易地从标准12导联ECG中获得，但其预测能力尚未建立。我们试图确定的预测能力的平面QRS-T角在非缺血性心肌病患者，并评估QRS-T角的行为随着时间的推移。方法和结果-基线QRS-T角在非缺血性心肌病治疗评价（DEFINITE）试验的除颤器从455例进行了测量。所有患者均患有非缺血性心肌病，纽约心脏协会I至III级心力衰竭，非持续性室性心动过速或频发室性异位。主要终点（总死亡率、适当的植入式心律转复除颤器电击或心脏骤停复苏的复合终点）发生在172例QRS-T角90度的患者中的25例（14.5%）（风险比，1.93; 95%置信区间，1.23至3.05; P = 0.002）。校正治疗组、年龄、性别、QRS时限、左前支传导阻滞、左心室射血分数、纽约心脏协会III级、房颤和糖尿病后，QRS-T角>90度仍是主要终点的显著预测因子（P = 0.039）。次要终点（总死亡率）发生在17/172例（9.9%）QRS-T角90度的患者中（风险比，1.79; 95%置信区间，1.03 - 3.10; P = 0.016）。分析了152例多次随访ECG的患者样本，以评估时间QRS-T角行为。QRS-T角的变化与左室射血分数和QRS时限随时间的变化相关结论平面QRS-T角>90 °是非起搏患者死亡、合适的植入式心律转复除颤器电击或心脏骤停复苏的复合终点的重要预测因子，伴有频繁或复杂心室异位的轻度至中度症状性非缺血性心肌病患者。QRS-T角随左室射血分数和QRS时限的变化具有可预测性。
Background - The planar QRS-T angle can be easily obtained from standard 12-lead ECGs, but its predictive ability is not established. We sought to determine the predictive ability of the planar QRS-T angle in patients with nonischemic cardiomyopathy and to assess QRS-T angle behavior over time.Methods and Results - Baseline QRS-T angles from 455 patients in the Defibrillators in Nonischemic Cardiomyopathy Treatment Evaluation ( DEFINITE) trial were measured. All patients had nonischemic cardiomyopathy, New York Heart Association class I to III heart failure, and nonsustained ventricular tachycardia or frequent ventricular ectopy. The primary end point ( a composite of total mortality, appropriate implantable cardioverter-defibrillator shock, or resuscitated cardiac arrest) occurred in 25 of 172 patients ( 14.5%) with a QRS-T angle 90 degrees ( hazard ratio, 1.93; 95% confidence interval, 1.23 to 3.05; P = 0.002). A QRS-T angle >90 degrees remained a significant predictor of the primary end point ( P = 0.039) after adjustment for treatment group, age, gender, QRS duration, left bundle-branch block, left ventricular ejection fraction, New York Heart Association class III, atrial fibrillation, and diabetes mellitus. The secondary end point ( total mortality) occurred in 17 of the 172 patients (9.9%) with a QRS-T angle 90 degrees ( hazard ratio, 1.79; 95% confidence interval, 1.03 to 3.10; P = 0.016). A sample of 152 patients with multiple follow-up ECGs was analyzed to assess temporal QRS-T angle behavior. Changes in the QRS-T angle correlated with changes in left ventricular ejection fraction and QRS duration over time ( P 0.001).Conclusions A planar QRS-T angle >90 degrees is a significant predictor of a composite end point of death, appropriate implantable cardioverter-defibrillator shock, or resuscitated cardiac arrest in nonpaced, mild to moderately symptomatic patients with nonischemic cardiomyopathy with frequent or complex ventricular ectopy. QRS-T angles changed predictably with left ventricular ejection fraction and QRS duration.