The Relationship Between Augmentation Of QRS Complexe Wave Amplitude And Serum Level Of Brain Natriuretic Peptide In Patients With Heart Failure Before And After Diuresis Therapy

Objective: To assess the effect of diuresis-based fluid loss in patients treated for heart failure(HF) on QRS complexe wave amplitude(∑QRSWA) and the correlation of augmentation of∑QRSWA and serum level of Brain Natriuretic Peptide(BNP). Methods: Thirty patients with HF received diuresis.∑QRSWA from 12 leads(12∑QRSWA), from leadsⅠ+Ⅱ(2∑QRSWA) , from 6-limb leads(6∑QRSWA) and PR-interval, QRS axis, QRS duration(QRSd), QTc-interval from 12 leads were calculated and recorded before diuresis and after treatment in the third day, the sixth day and the ninth day respectively. The amount of urine after treatment every 3 days in the 9 days was recorded respectively. BNP-32 before diuresis and after treatment in the ninth day were measured with enzyme-linked immunosorbent assay(ELISA). Serum sodium, chlorine, albumin, creatinine, hemoglobin, hematocrit before diuresis and after treatment in the third day were also measured respectively.Results: 12∑QRSWA, 2∑QRSWA and 6∑QRSWA after treatment in the third day , the sixth day and the ninth day were 154.0±55.0mm,169.7±62.5mm,179.6±65.7mm;16.7±7.5mm,17.8±7.4mm,19.9±8.1mm;44.1±19.5mm,49.7±20.4mm,55.1±24.5mm, which were significantly higher than 12∑QRSWA, 2∑QRSWA and 6∑QRSWA before diuresis respectively(136.4±56.4mm,14.7±7.3mm,33.9±18.4mm)(P<0.01). Serum BNP-32 level after treatment in the ninth day was significantly lower than before diuresis in the patients (102.7±47.2pg/ml vs 2647.9±1951.4pg/ml()P<0.01). However PR-interval, QRS axis, QRSd, QTc-interval were no differences in the patients before diuresis and after treatment in the third day, the sixth day and the ninth day(P>0.05).Serum sodium, chlorine, albumin, creatinine, hemoglobin, hematocrit were no differences in the patients before diuresis and after treatment in the third day(P>0.05). Augmentation of 12∑QRSWA, 2∑QRSWA and 6∑QRSWA after treatment in the sixth day versus the third day correlated respectively positively with increasing of the amount of urine after treatment the second 3 days versus the first 3 days (r=0.514, P<0.01;r=0.463, P=0.01;r=0.504, P<0.01). Augmentation of 12∑QRSWA, 2∑QRSWA and 6∑QRSWA after treatment in the ninth day versus before diuresis correlated respectively negatively with decreasing of serum BNP-32 level after treatment in the ninth day versus before diuresis(r=-0.497,P<0.01;r=-0.435,P<0.05;r=-0.472,P<0.01).Conclusion: Augmentation of∑QRSWA in HF patients after diuresis can be used as an easily obtainable and reliable index of both the fluid loss and heart function improvement .