The Selvester QRS score as a predictor of cardiac events in nonischemic dilated cardiomyopathy
The Selvester QRS score as a predictor of cardiac events in nonischemic dilated cardiomyopathy
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DOI：
10.1016/j.jjcc.2017.09.002
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发表时间：
2018-03-01
影响因子：
2.5
通讯作者：
Murohara, Toyoaki
中科院分区：
文献类型：
--
作者：
Hiraiwa, Hiroaki;Okumura, Takahiro;Murohara, Toyoaki
背景：心肌纤维化与非缺血性扩张型心肌病（NIDCM）患者的不良预后相关。12导联心电图Selvester QRS记分与心肌梗死患者的心肌瘢痕数量和不良预后相关。然而，它在NIDCM患者中的使用是有限的。我们调查的预后价值的QRS评分及其与胶原蛋白体积分数（CVF）在NIDCM patients.Methods：我们连续91例NIDCM患者（66名男性，53 - 13岁）没有永久性起搏器或心脏起搏治疗设备。Selvester QRS评分由两名心脏病专家在NIDCM诊断时计算。所有患者均随访4.5 +/- 3.2年。心脏事件定义为心源性死亡、因心力衰竭恶化住院和致死性心律失常的复合事件。结果：基线时，左心室射血分数为32 +/-9%，血浆脑钠肽水平为80 [43-237] pg/mL，平均Selvester QRS评分为4.1分。观察到20起心脏事件（心源性死亡，n = 1;因心力衰竭恶化住院，n = 16;致死性心律失常，n = 3）。考克斯比例风险回归分析显示，Selvester QRS评分是心脏事件的独立决定因素（风险比，1.32; 95%置信区间，1.05-1.67; p = 0.02）。最佳截止值确定为3点，灵敏度为85%，特异性为47%（曲线下面积，0.688，p = 0.011）。在Kaplan-Meier生存分析中，QRS评分>= 3组发生的心脏事件多于QRS评分
Background: Myocardial fibrosis is associated with poor prognosis in nonischemic dilated cardiomyopathy (NIDCM) patients. The Selvester QRS score on 12-lead electrocardiogram is associated with both the amount of myocardial scar and poor prognosis in myocardial infarction patients. However, its use in NIDCM patients is limited. We investigated the prognostic value of the QRS score and its association with collagen volume fraction (CVF) in NIDCM patients.Methods: We enrolled 91 consecutive NIDCM patients (66 men, 53 13 years) without permanent pacemakers or cardiac resynchronization therapy devices. The Selvester QRS score was calculated by two expert cardiologists at NIDCM diagnosis. All patients were followed up over 4.5 +/- 3.2 years. Cardiac events were defined as a composite of cardiac death, hospitalization for worsening heart failure, and lethal arrhythmia. We also evaluated CVF using endomyocardial biopsy samples.Results: At baseline, the left ventricular ejection fraction was 32 +/- 9%, plasma brain natriuretic peptide level was 80 [43-237] pg/mL, and mean Selvester QRS score was 4.1 points. Twenty cardiac events were observed (cardiac death, n = 1; hospitalization for worsening heart failure, n = 16; lethal arrhythmia, n = 3). Cox proportional hazard regression analysis revealed that the Selvester QRS score was an independent determinant of cardiac events (hazard ratio, 1.32; 95% confidence interval, 1.05-1.67; p = 0.02). The best cut-off value was determined as 3 points, with 85% sensitivity and 47% specificity (area under the curve, 0.688, p = 0.011). In Kaplan-Meier survival analysis, the QRS score >= 3 group had more cardiac events than the QRS score