| Background: Heart failure is the end and serious stage of all kinds of cardiovascular disease,and cardiac structure and(or)function change,following by ventricular repolarization abnormalities,and malignant arrhythmia and even sudden death can occur.The main electrocardiogram changes of ventricular repolarization abnormalities are QT interval prolongation and T wave morphology changing.Researches show that T wave morphology parameteres of body surface ECG are the valid indexes to predict the bad prognosis of cardiovascular disease.Methods: The medical information of patients with and without heart failure is from a single center.The enrolling criteria for group with heart failure were: 1.All hospitalized patients with heart failure from May 2014 years to December 2015 years enrolled into the the Cardiovascular Hospital of the First Hospital of Dalian Medical University;2.Adult patients(aged more than 18 years old);3.Diseases are diagnosed meeting the criterion for heart failure guideline of 2016 proposed by European Society Cardiology.The exclusion criteria for group of heart failure patients were: 1.Electrocardiogram showed acute myocardial infarction;2.Electrocardiogram showed atrial fibrillation or atrial flutter;3.Electrocardiogram showed secondary T wave changes graph,including left ventricular high voltage,left and(or)right bundle branch block,preexcitation,frequent ventricular premature,ventricular tachycardia,pacing rhythm;4 ECG datas with unstable baseline,poor quality or incomplete.The enrolling criteria for patients without heart failure were: 1.Hospitalized patients from May 2014 years to December 2015 years at the the the First Hospital of Dalian Medical University;2.Adult patients(aged more than 18 years old).The exclusion criteria for group without heart failure were: 1.Patients with cardiovascular disease,including hypertension,coronary disease,arrhythmia,cardiomyopathy,valvular heart disease,heart failure;2.ECG showed left ventricular high voltage,ST-T changing;3.Biochemical test which was taken three days before or after electrocardiogram examination indicated electrolyte disorder;4.ECG data with unstable baseline,poor quality or incomplete.Clinical data included patients' age,gender,time for being hospitalized,underlying diseases(hypertension,diabetes mellitus,coronary disease,old myocardial infarction,arrhythmia severe valvular heart disease,cardiomyopathy),left ventricular ejection fraction,left ventricular diameter,BNP,drugs that affect the prognosis of heart failure including angiotensin converting enzyme inhibitors(ACEI)or angiotensin receptor antagonist(ARB),beta receptor blockers,spironolactone.All T wave morphology parameters were automatically calculated by the special computer software,including QRS-T angle,TpTe interval,ratio of T wave main components,QTd dispersion and QTp dispersion,flat score of T wave,asymmrtry score of T wave,notch score of T wave,MCS of Twave.The parameter results were the average values of 12 lead.Following-up by telephone for heart failure group,end point were death,and cardiac death included pump failure,acute myocardial infarction,malignant arrhythmia.Non heart failure group did not need followed-up.In this study,firstly,we compared base-line date and T wave morphology parameters of patients with heart failure and control group(patients without heart failure);secondly,we went on a further study of patients with heart failure that including: comparing base-line date and T wave morphology parameters of cardiac death patients with and control group(survivals);survival time analysis of patients with heart failure,mono-factors and multi-factors COX regression analysis of heart failure patients with cardiac death,value analysis of significant parameter(P<0.05)as an index that for judging prognosis of cardiac death of heart failure.Results: 219 patients with heart failure and 210 patients without heart failure were enrolled into this research,comparing gender and age,there were no significant differences between two groups;T wave morphology parameters showed significant differences between two groups,except for QTp dispersion;QRS-T angle,TpTe interval,QT dispersion,ratio of T wave main component,flat score,notch score,MCS of heart failure group were higher than the non heart failure group,but T wave asymmetry score of heart failure group was lower than the non heart failure group.After a follow-up about 17.50 + 7.40 months for patients with heart failure,the number of all-cause death patients was16,and cardiac death patients was 11,survival patients was 203,cardiac death mortality was 5.02%.Baseline data did not showed any significant difference(P > 0.05)between the cardiac death group and survival group,except for hypertension(P=0.381);but comparing T wave morphology parameters,QRS-T angle of cardiac death group was higher than the survival group,(142(126-161)VS 87(47-120),P=0.002),MCS-score of cardiac death group was lower than that of the survival group(76(71-88)VS 84(72-101),P=0.047),Asym-score of cardiac death group was lower thanthat of the survival group(7(3-10)VS 8(4-16),P=0.048),there were not have differences between two groups for other parameters.The average survival time within the following-time was 33.35 months for heart failure patients,95% confidence interval is 32.06 to 33.72 months,1 year cumulative survival rate was 99.5% and 2 year cumulative survival rate was 97.7%.Comparing with patients whose QRS-T angle were less than 90°,the 1 years survival rate of patients with QRS-T angle more than 90 °significantly decreased.The single factors COX regression analysis indicated that the average survival time of patients suffered from atrial fibrillation or atrial flutter and heart failure was shorter than those without atrial fibrillation or flutter,(31.112±0.546 VS 33.937±0.370,P=0.039),QRS-T angle had difference between cardiac death group and survival group(33.18±0.14 VS 32.35±0.68,P=0.002),gender,age,left ventricular ejection fraction,companying with other diseases and other T wave morphology parameters had no significance(P >0.05),but P value of the QTp dispersion was the critical value(P=0.083).Multiple factor COX regression analysis showed that QRS-T angle reminded significant(P=0.020)after adjusted by age,gender,ejection fraction after correction and so on,and the relative risk was 12.040.Using ROC curve to estimate the predicting value for heart failure prognosis of QRS-T angle,the area under the ROC curve were 0.733(> 0.50),P 0.002(< 0.05),95% confidence interval 0.619-0.926,QRS angle was a significant index.Conclusion :T wave morphology parameters in patients with heart failure are significantly different compare with patients without heart failure,indicating that T wave morphology parameters are valid indicators for abnormal ventricular repolarization.Analysing of T wave morphology parameters between patients with heart failure ended with cardiac death and survivals found that QRS-T angle is the independent risk factors for the bad prognosis of heart failure,and the QRS-T angle is an effective standard as a prognostic index. |
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