Predictive value of prolonged QRS wave duration on adverse cardiac events in elderly patients with hypertension and heart failure / 中国基层医药

ABSTRACT

Objective:To investigate the predictive value of prolonged QRS duration of electrocardiogram for adverse cardiac events in elderly patients with hypertension and heart failure.Methods:From April 2015 to May 2018, 226 elderly patients with hypertension complicated with heart failure were selected in the Third Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine.After admission, 18 leads ECG were examined immediately.According to the time limit of QRS wave, the patients were divided into 157 cases of QRS wave≤120 ms group and 69 cases of QRS wave>120 ms group.The related indicators of cardiac function, serum N-terminal brain natriuretic peptide precursor(NT-proBNP) and the incidence of major adverse cardiovascular events (MACE) at 6 months after discharge were compared between the two groups.The time limit of QRS wave in patients with MACE and those without MACE was compared, and the predictive value of QRS wave time limit in patients with MACE was analyzed by ROC curve.Results:The LVEF[(37.49±4.03)%] of the patients with QRS wave duration>120 ms was significantly lower than that of the patients with QRS wave duration<120 ms [(44.37±4.92)%]( t=10.205, P<0.05). The LVEDD [(59.03±3.15)mm], LVMI[(147.38±16.28)g/m 2] and serum NT-proBNP [(1097.59±216.49)ng/L] in the patients with QRS wave duration>120 ms were significantly higher than those in the patients with QRS wave duration<120 ms [(56.39±3.97)mm, (138.96±15.36)g/m 2 and (825.36±185.36)ng/L] ( t=4.887, 3.726, 9.649, all P<0.05). The incidence of MACE in the patients with QRS duration>120 ms (53.62%) was significantly higher than that in the patients with QRS duration<120 ms (20.38%)(χ 2=24.973, P<0.05). The QRS wave duration was negatively correlated with LVEF( r=-0.316, P<0.05), and positively correlated with LVEDD, LVMI and serum NT-proBNP( r=0.362, 0.405, 0.378, P<0.05). The time limit of QRS wave in the patients with MACE[(137.64±21.05)ms] was significantly longer than that in the patients without MACE [(112.65±19.85)ms]( t=8.556, P<0.05). The predictive value of QRS wave duration of ROC curve for MACE was 0.852. Conclusion:QRS wave duration is closely related to cardiac function and serum NT-proBNP level in elderly patients with hypertension and heart failure, and prolonged QRS wave duration has good predictive value for adverse cardiac events, which can be used as a clinical monitoring index.