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目的探讨T波峰末间期(TpTe)对慢性收缩性心力衰竭(简称心衰)患者预后的预测价值。方法回顾性调查和分析湖北地区8地市12家三级甲等医院2000年至2010年心衰住院患者临床资料,所有患者电话随访。根据TpTe四分位间距分为≥114 ms、88～113 ms、68～87 ms和≤67 ms组。单因素Kaplan-Meier曲线分析TpTe各组总死亡、心血管病死亡、心衰死亡、和心源性猝死有差异性。多因素Cox生存分析确认心衰患者不同预后的危险因素。受试者工作特征曲线(ROC曲线)分析TpTe、槡TpTe/RR是否增加预测的灵敏度和特异度。结果①共11067例患者纳入本次研究。将性别、年龄、心率、左室射血分数、病因、肾功能、心房颤动及治疗措施等指标加入多因素Cox回归分析,发现TpTe延长是总死亡、心血管病死亡和心衰死亡增加的独立危险因素,风险(95%CI,P)分别为1.002(1.001～1.002,<0.01)、1.002(1.001～1.003,<0.01)和1.002(1.001～1.003,<0.01);②ROC曲线分析发现不包含QTc、TpTe和槡TpTe/RR的预测模型预测总死亡、心血管病死亡、心衰死亡和心源性猝死的响应率分别为79.30%(Chic-square 1 893.25,P<0.01)、72.20%(Chic-square 2 771.33,P<0.01)、73.90%(Chic-square 2998.21,P<0.01)和71.90%(Chic-square 323.07,P<0.01)。分别加入QTc、QTc和TpTe、QTc和槡TpTe/RR的模型不增加预测模型的灵敏度和特异度。结论虽然TpTe延长增加慢性收缩性心衰患者的死亡风险,但不增加预测的灵敏度和特异度。
Objective To investigate the predictive value of TpTe in the prognosis of patients with chronic systolic heart failure (HF). Methods The clinical data of 12 hospitalized patients with heart failure in 12 tertiary hospitals in 8 districts of Hubei Province from 2000 to 2010 were retrospectively investigated and analyzed. All patients were followed up by phone. According to the interquartile range of TpTe, it was divided into groups of ≥114 ms, 88 ~ 113 ms, 68 ~ 87 ms and ≤67 ms. Single-factor Kaplan-Meier curve analysis of total TpTe death, cardiovascular death, heart failure, and sudden cardiac death are different. Multivariate Cox survival analysis identified risk factors for different prognoses in patients with heart failure. The receiver operating characteristic curve (ROC curve) analyzes whether TpTe, 槡 TpTe / RR increase the sensitivity and specificity of the prediction. Results ① A total of 11067 patients were included in this study. The multivariate Cox regression analysis of gender, age, heart rate, left ventricular ejection fraction, etiology, renal function, atrial fibrillation and treatment measures showed that TpTe prolongation was independent of total death, cardiovascular death and heart failure The risk factors (95% CI, P) were 1.002 (1.001-1.002, <0.01), 1.002 (1.001-1.003, <0.01) and 1.002 (1.001-1.003, <0.01) respectively. ②The ROC curve analysis did not include QTc The predictive models of TpTe and 槡 TpTe / RR were 79.30% (Chic-square 1 893.25, P <0.01) and 72.20% (Chic) respectively for cardiovascular death, cardiovascular death, heart failure and sudden cardiac death -square 2 771.33, P <0.01), 73.90% (Chic-square 2998.21, P <0.01) and 71.90% (Chic-square 323.07, P <0.01). The models that were added to QTc, QTc, and TpTe, QTc, and TpTe / RR, respectively, did not increase the sensitivity and specificity of the prediction model. Conclusions Although TpTe prolongs the risk of death in patients with chronic systolic heart failure, it does not increase the sensitivity and specificity of the predictions.