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Objective To evaluate the value of two-dimensional speckle tracking echocardiography (2D-STE) in assessing left ventricular systolic function,diastolic function and synchrony with different QRS complex duration in complete left bundle branch block (CLBBB) patients with preserved left ventricle ejection fraction (LVEF).Methods A total of 44 patients with CLBBB and LVEF≥50％ were included.All the patients were divided into two groups based on QRS duration,QRS＞150 ms as wide QRS group and 120 ms≤QRS≤150 ms as narrow QRS group.And 30 healthy people were included as control group.Two-dimensional echocardiography and 2D-STE were performed.Ieft ventricle longitudinal peak stain of global,septum and free wall (LS-G,LS-Sept,LS-Lat),standard deviation of time to peak systolic strain for the 18 left ventricular segments (SDt) and index of left yen tricular diastolic function (EDT,E/A and E/e') were measured.Results SDt values of wide QRS group and narrow QRS group were significantly higher than that of control group (both P＜0.01).And SDt of wide QRS group was significantly higher than that of narrow QRS group (P＜0.05).LVEF and LS-G in wide QRS group were significantly lower than those in both narrow QRS group and control group (all P＜ 0.05),while there was no significant difference between narrow QRS group and control group (all P＞0.05).The LS-Sept in wide QRS group and narrow QRS group were both lower than that of control group (both P ＜0.01).And LS-Sept in wide QRS group was lower than that of narrow QRS group (P＜0.01).LS-Lat in narrow QRS group was separately higher than those of both wide QRS group and control group (both P＜0.05),while there was no significant difference of LS-Lat between wide QRS group and control group (P＞0.05).Compared with control group,E/A and EDT decreased and of E/e' increased in both wide QRS group and narrow QRS group (all P＜0.05).While there was no significant difference between wide QRS group and narrow QRS group (all P＞0.05).Conclusion In patients of wide QRS CLBBB with preserved LVEF,left ventricular systolic,diastolic function and synchrony decrease,while left ventricular systolic function of patients with narrow QRS do not significantly decrease.
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Objective To study the effects of QRS-complex duration of patients with chronic left heart failure on their in-hospital prognosis. Methods Total 174 patients admitted for chronic left heart failure ( New York Heart Association class 3 and 4 ) from January 2014 to June 2015 were enrolled the study. They were divided into two groups according to the QRS duration at admission:normal QRS duration group (QRS ≤120 ms, n=145) and prolonged QRS group (QRS ﹥120 ms, n=29). The differences of clinical characteristics and incidences of exacerbated left heart failure, fatal arrhythmias and cardiac death during hospitalization were compared between the two groups. The influences of QRS duration on in-hospital adverse cardiovascular events was analyzed by logistic regression. Resu1ts The proportion of males (75. 9% vs. 24. 1%, P=0. 001), plasma B-type natriuretic peptide (BNP) (7. 1 ± 0. 8 vs. 6. 6 ± 1. 0, P=0. 02), left ventricular end diastolic diameter (LVEDd) [(60. 7 ± 9. 9)mm vs. (53. 5 ± 10. 8)mm, P=0.001], left ventricular end systolic diameter (LVESd) [(49.1 ±13.3)mm vs. (39.7 ±13.0)mm, P﹤0. 001], and the incidence of exacerbated left heart failure (20. 7% vs. 4. 8%, P = 0. 003), fatal arrhythmias (55. 2% vs. 21. 4%, P ﹤0. 001) and cardiac death (6. 9% vs. 0. 7%, P =0. 019) during hospitalization were significantly higher in the prolonged QRS group than in the normal QRS group. Left ventricular ejection fraction( LVEF) in the prolonged QRS group was significantly lower than in the normal QRS group (39. 6% ±17. 3% vs. 50. 5% ± 17. 3%, P =0. 002). Heart rates [(92. 4 ± 21. 4)bpm vs. (81. 6 ± 19. 9)bpm,P=0. 035], plasma BNP(7. 2 ± 0. 8 vs. 6. 7 ± 1. 0, P=0. 029), LVEDd(63. 5 ± 9. 1 vs. 57. 9 ± 9. 1, P=0. 015), LVESd (52. 9 ± 12. 2 vs. 44. 3 ± 11. 8, P=0. 005), incidences of left heart failure deterioration (18. 2% vs. 3. 2%, P=0. 018), fatal arrhythmias (63. 6% vs. 36. 5%, P=0. 027) and cardiac death ( 9. 1% vs. 0%, P=0. 015 ) during hospitalization among male patients in the prolonged QRS group were significantly higher than those in the normal QRS group, but LVEF ( 35. 0% ± 15. 3%vs. 47. 1% ± 16. 2%, P =0. 003 ) was on the opposite. The incidence of left heart failure deterioration among female patients in the prolonged QRS group was higher than that in the normal QRS group ( 28. 6%vs. 6. 1%, P=0. 034). QRS complex duration was positively related to LVEDd ( r=0. 4019, P﹤0. 001) and LVESd ( r =0. 3289, P ﹤0. 001 ) . LVEF in male patients was significantly lower than in female patients (40. 0% ± 16. 7% vs. 53. 2% ± 17. 6%, P﹤0. 001). On the contrary, LVEDd [(59. 4 ± 9. 4) mmvs. (50.3±10.6)mm,P﹤0.001],LVESd[(46.6±12.5)mmvs. (36.2±12.4)mm,P﹤0.001] were greater in male patients than in female patients. After adjusting for gender , age, cigarette smoking, history of high blood pressure, serum creatinine, low-density lipoprotein cholesterol, LVEF, LVEDd, LVESd, use of angiotensin converting enzyme inhibitors ( ACEI) or angiotensin receptor blockers ( ARB) and aldosterone receptor blockers, multiple logistic regression analysis showed that prolonged QRS complex duration is an independent risk factor of adverse prognosis for the patients with HF during hospitalization (OR=4. 21,95%CI:1. 59-11. 12,P=0. 004), and female gender is a protective factor for them ( OR=0. 304,95%CI:0. 116-0. 793,P=0. 015). Conc1usions The incidences of left heart failure deterioration, fatal arrhythmias and cardiac death in the chronic left heart failure patients with prolonged QRS duration were higher than in those with normal duration. Female gender is a protective factor for chronic left heart failure.
ABSTRACT
Objective To investigate the relationship among electrocardiogram QRS complex duration,left ventricular ejection fraction( LVEF),N-terminal pro-brain natriuretic peptide( NT-proBNP)and their relation to New York Heart Association (NYHA)functional classification in patients with chronic heart failure(CHF),and observe the intervention effects of Shenfu injection(SFI)on patients with CHF. Methods A total of 72 CHF patients were randomly assigned to treatment group(36 cases)and control group(36 cases). Patients in the control group received standard care,and those in the treatment group received standard care plus 1. 0 mL·kg-1 ·d-1 of SFI in 5% glucose for two weeks. Before and after the treatments,the electrocardiogram QRS complex duration,LVEF,NT-proBNP were measured and NYHA functional classification was evaluated. Results Electrocardiogram QRS complex duration was negatively correlated with LVEF and was positively correlated with NT-proBNP and NYHA functional classification( P〈0. 05 ). After the treatment,the proportion of patients with NYHA classⅠ-Ⅱsignificantly increased and classⅢ-Ⅳsignificantly decreased in both groups. The treatment group was superior to the control group in reinstating cardiac function( P〈0. 05 ). After the treatment,electrocardiogram QRS complex duration and the levels of NT-proBNP were significantly descended and LVEF were significantly ascended in both groups(P〈0. 05). The level of NT-proBNP in the treatment group was significantly lower than in the control group(P〈0. 05),but electrocardiogram QRS complex duration and LVEF did not show significant difference. The prior-and post-treatment difference in electrocardiogram QRS complex duration and LVEF was more obvious in the treatment group than in the control(P〈0. 05). Conclusion The extension of electrocardiogram QRS complex duration is correlated with plasma NT-proBNP elevation and cardiac dysfunction,which can be used as a reference for disease progression or medication efficacy. SFI is effective on CHF of the yang-qi deficiency type.