心电图参数及Lorenz散点图对慢性心力衰竭患者预后的预测价值

Predictive value of electrocardiogram parameters and Lorenz scatter plot for prognosis in patients with chronic heart failure

摘要:

目的 探讨心电图参数及Lorenz散点图形态对慢性心力衰竭患者预后的预测价值。方法 回顾性分析2024年1月—2025年1月南通市肿瘤医院及南通市通州区平潮中心卫生院就诊的126例慢性心力衰竭患者的临床资料，依据随访结局分为预后良好组（71例）与预后不良组（55例）。比较两组患者的临床资料、心电图指标、Lorenz散点图形态；采用多因素一般Logistic回归模型分析慢性心力衰竭预后不良的危险因素；绘制受试者工作特征（ROC）曲线评估各指标及联合检测预测慢性心力衰竭预后的效能。结果 预后不良组左室射血分数（LVEF）低于预后良好组（P <0.05），预后不良组N末端B型脑钠肽前体（NT-proBNP）高于预后良好组（P <0.05），预后不良组频发房性期前收缩发生率、频发室性期前收缩发生率、ST-T改变发生率、心房颤动发生率均高于预后良好组（P <0.05），Lorenz散点图分布不规则或复杂型占比高于预后良好组（P <0.05）。多因素一般Logistic回归分析结果显示，频发房性期前收缩［O^R =9.197（95% CI：2.509，33.712）］，频发室性期前收缩［O^R =18.565（95% CI：3.914，88.055）］，ST-T改变［O^R =14.629（95% CI：2.330，91.854）］，心房颤动［O^R =24.287（95% CI：2.463，239.453）］，Lorenz散点图呈扇形、四分布、三分布或格子状［O^R =37.894（95% CI：2.463，239.453）］，Lorenz散点图呈不规则或复杂型［O^R =34.642（95% CI：7.128，168.365）］均为慢性心力衰竭患者预后不良的危险因素（P <0.05）。ROC曲线分析结果显示，多指标联合预测曲线下面积为0.903（95% CI：0.845，0.961），敏感性为67.3%（95% CI：0.533，0.793），特异性为97.2%（95% CI：0.902，0.997）。结论 频发房性期前收缩、频发室性期前收缩、ST-T改变、心房颤动及异常Lorenz散点图形态均为慢性心力衰竭患者预后不良的独立危险因素，多指标联合检测可显著提升预后预测效能。

Abstract:

Objective To evaluate the prognostic significance of electrocardiographic manifestations and Lorenz scatter plot patterns in patients with chronic heart failure.Methods A total of 126 patients diagnosed with chronic heart failure who received treatment at Nantong Cancer Hospital and Pingchao Central Hospital between January 2024 and January 2025 were retrospectively enrolled. Based on follow-up results, the patients were divided into a favorable prognosis group (71 cases) and an unfavorable prognosis group (55 cases). Clinical data, electrocardiogram parameters, and Lorenz scatter plot characteristics were compared between the two groups. Independent risk factors for poor prognosis were identified using multivariate logistic regression. The predictive performance of these factors was evaluated via receiver operating characteristic curve analysis.Results The left ventricular ejection fraction (LVEF) in the poor prognosis group was lower than that in the good prognosis group, while the levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), the incidence rates of frequent premature atrial contractions, frequent premature ventricular contractions, ST-T changes and atrial fibrillation, as well as the proportion of irregular or complex Lorenz scatter plot patterns were higher than those in the good prognosis group (P < 0.05). Multivariate logistic regression analysis showed that frequent premature atrial contractions, frequent premature ventricular contractions, ST-T changes, atrial fibrillation, fan-shaped, quadri-distributed, tri-distributed or lattice Lorenz scatter plots, and irregular or complex Lorenz scatter plots were independent risk factors for poor prognosis in patients with chronic heart failure (P < 0.05). Receiver operating characteristic (ROC) curve analysis indicated that single electrocardiographic indicators and Lorenz scatter plot parameters had limited predictive performance. The area under the curve (AUC) of combined detection was 0.903 (95% CI: 0.845, 0.961), with a sensitivity of 67.3% (95% CI: 0.533, 0.793) and a specificity of 97.2% (95% CI: 0.902, 0.997).Conclusion Frequent premature atrial contractions, frequent premature ventricular contractions, ST-T changes, atrial fibrillation, and abnormal Lorenz scatter plot patterns are independent risk factors for poor prognosis in patients with chronic heart failure. Multi-indicator combined detection can significantly improve the predictive efficacy.