目的 探讨QT离散度对射血分数保留的心力衰竭患者心肌重构和预后的判断.方法 76例射血分数保留的心力衰竭患者入院时记录基础静态12导联同步心电图,计算QT离散度(QTd),以及校正心率后的QT离散度(QTcd),平均随访10.3 ±2.6个月,搜集患者基本情况,用药详情,实验室检查,超声心动图等临床资料,统计患者病死率以及事件发生率.结果 随访期间11例死亡(14.5％),QTcd为81.6±25.7ms,存活者65例,其中27例发生心血管事件再入院(35.5％),QT离散度为73.8±24.7ms,其余38例无心血管事件发生(50％),QT离散度为(64.8±28.7)ms;单因素回归分析显示QTcmax和QTcd为该类患者死亡和心血管事件发生的危险因素(P＜0.05);在校正多因素分析后发现,QTcd为HFpEF患者死亡和心血管事件发生的独立危险因素(P＜0.05);相关分析显示QTcd与左心室收缩末期内径(P＜0.05)、左心室舒张末期内径(P＜0.05)明显相关.结论 QT离散度对射血分数保留心力衰竭患者的心肌重构和预后的判断具有临床价值.%Objective To evaluate the value of QT dispersion in myocardial remodeling and prognosis in patients with chronic heart failure with preserved ejection fraction (HFpEF).Methods Totally 76 patients admitted to hospital due to HFpEF in the period between years 2013-2015 were recruited.A 12-lead ECG,chest radiograph,echocardiogram,and serum for biochemical analysis were obtained at baseline.Patients were followed for 10.3 ± 2.6 months,the basic information of patients,medication details,laboratory examination,echocardiography and other clinical data,and the mortality rate and the incidence of the disease were collected and analyzed.Results During the follow-up,11 patients died (14.5％) with QT dispersion for 81.6 ± 25.7ms.65 patients survived,including 27 cases of readmission for cardiovascular events (35.5％) with QT dispersion for 73.8 ± 24.7ms.The remaining 38 patients without cardiovascular events (50％) with QT dispersion 64.8 ± 28.7ms.Univariate analysis showed that QTcmax and QTcd were the risk factors for death and cardiovascular events in HFpEF patients (P ＜ 0.05).Cox's proportional hazards regression model analysis found that QTcd was the independent risk factors for death and cardiovascular events in HFpEF patients (P ＜ 0.05).Pearson's correlation analysis showed that QTcd was significantly related with left ventricular end systolic diameter (P ＜ 0.05),left ventricular end diastolic diameter (P ＜ 0.05).Conclusion QT dispersion has clinical value in the diagnosis of myocardial remodeling and prognosis in patients with HFpEF.
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