| Part ?:Distribution and predictors of PR interval and its components in hospitalized patients with heart failureObjective:The epidemiological characteristics of the PR interval and its components in hospitalized patients with heart failure are to be determined.This study aims to explore the distribution and predictors of the PR interval and its components on body surface 12-lead electrocardiogram in hospitalized heart failure patients.Methods:We retrospectively enrolled heart failure patients that were hospitalized between 2014 to 2017,and collected their baseline data and PR interval,P wave duration,PR segment and P wave duration/PR interval ratio on 12-lead ECG at admission.Univariate correlation analysis and multiple linear regression analysis were performed to explore the clinical indicators and transthoracic echocardiographic parameters that were related to the research variables.Results:A total of 1182 hospitalized patients with heart failure were enrolled.The PR interval,P wave duration,and PR segment in our population were wider than those in the community population,while the P wave duration/PR interval ratio was lower.When PR interval,P wave duration,and PR segment were grouped by quartiles,the New York Heart Association(NYHA)cardiac function classification and peripheral blood N-terminal pro-BNP(NT-proBNP)levels were significantly different between the groups(all P<0.05).In multiple linear regression analysis,a higher height was an independent predictor for longer PR interval and longer P wave duration(every 10 cm increase:regression coefficient 6.22,P<0.001;regression coefficient 4.83,P<0.001).The correlation of PR interval with P wave duration was moderate(correlation coefficient 0.38,P<0.001),and the correlation with PR segment was strong(correlation coefficient 0.79,P<0.001).Compared with the PR segment,the PR interval and P wave duration had a greater correlation with the atria and ventricular diameters measured by transthoracic echocardiography.The PR interval and P wave duration were significantly correlated with the anteroposterior diameter of the right ventricle in heart failure with reduced ejection fraction(HFrEF)patients(correlation coefficients:0.17 and 0.13,respectively,P<0.001),but there was no significant correlation in patients with non-HFrEF.Conclusion:In hospitalized patients with heart failure,the PR interval,P wave duration,and PR segment were associated with NYHA cardiac function classification and peripheral blood NT-proBNP levels.Further studies are needed to determine their value of risk stratification.A higher height was an independent predictor for longer PR interval and longer P wave duration.The correlation between PR interval and P wave duration was weaker than that with PR segment.Part ?:The prognostic value of PR interval and its components in hospitalized patients with heart failureObjective:The correlation between PR interval as well as its components and patient outcome showed controversial results in previous studies.This study aimed to explore the prognostic value of the PR interval and its components on 12-lead ECG in hospitalized patients with heart failure.Methods:We retrospectively enrolled heart failure patients that were hospitalized between 2014 to 2017,and collected their baseline data and PR interval,P wave duration,PR segment and P wave duration/PR interval ratio on 12-lead ECG at admission.The primary endpoint was the composite endpoint of all-cause death and heart transplantation.We used Cox proportional hazard regression models to evaluate the predictive value of the research variables to the primary endpoint,and explored the incremental contribution of the research variables to existing prognostic prediction models.Results:In 1182 hospitalized heart failure patients,after an average follow-up period of 2.39 years(interquartile range 0.77-3.48 years),the primary endpoint occurred in 310 patients.The PR interval was significantly correlated with the primary endpoint in the univariate and age-sex-adjusted Cox proportional hazards regression models,while the multivariate models did not suggest a significant and consistent association.The P wave duration was not significantly associated with the primary outcome.The increase of PR segment(for every 10ms increase:hazard ratio 1.041,95%confidence interval[CI]1.010-1.083,P=0.023)and decrease of the P wave duration/PR interval ratio(for every increase of 0.1:hazard ratio 0.856,95%CI 0.768-0.955,P=0.005)were independent predictors of the composite endpoint of all-cause death and heart transplantation.The PR segment and the P-wave duration/PR interval ratio were added to the initial prediction model.With a three-year risk of 10%and 30%for the primary endpoint as the cut-off point,the categorical NRI was significant for the PR segment(P=0.010)but not for the P-wave duration/PR interval ratio.The likelihood ratio test of the models before and after adding the new parameter was significant for both the variables,but the increase in C-index were not significant.The increase in PR segment and the decrease in the P wave duration/PR interval ratio were independent predictors of increased risk of the primary endpoint in patients with a height greater than 170cm(for each increase of 10ms:hazard ratio 1.153,95%CI 1.085-1.225,P<0.001;for each increase of 0.1:Hazard ratio 0.681,95%CI 0.571-0.812,P<0.001,respectively),but there were no significant association in shorter patients(P values for interaction:0.006 and 0.026,respectively).Conclusion:The increase in PR segment and the decrease in the P wave duration/PR interval ratio were independent predictors of the composite end point of all-cause death and heart transplantation in hospitalized heart failure patients,but the additional prognosis predicting value based on the existing prediction model was limited.The increase in PR segment and the decrease in the P wave duration/PR interval ratio were independent predictors of increased risk of the primary endpoint in the subgroup of higher but not shorter patients.Part ?:Clinical characteristics and prognosis of hospitalized heart failure patients with recovered left ventricular ejection fraction at discharge and those with preserved ejection fractionObjectives:To elucidate the characteristics of hospitalized heart failure with recovered ejection fraction(HFreEF)patients compared to heart failure with preserved ejection fraction(HFpEF)patients.Methods:We retrospectively included consecutive hospitalized heart failure patients with a left ventricular ejection fraction(LVEF)level of?40%at discharge.Patients were classified as HFreEF(any previously documented LVEF<40%and a maximum increase of LVEF?5%)or HFpEF(previous LVEF available but none less than 40%).Uni-and multi-variable Cox proportional-hazards models were used to determine the prognostic risk in HFreEF compared to HFpEF.The primary and secondary outcomes were cardiovascular mortality and all-cause mortality,respectively.Results:A total of 427 hospitalized heart failure patients were included in the baseline analyses,and 424 with complete follow-up data(HFreEF:n=117,median follow-up period:54 months)were included in the survival analyses.In the unadjusted Cox regression model,the cardiovascular mortality between the two groups were not significantly different(P=0.37).Whereas in age and sex-adjusted Cox regression model(hazard ratio,2.15;95%confidence interval[C1],L41-3.27;P=0.0004),Cox model fully adjusted for only clinical factors and including medication factors(hazard ratio,1.88;95%CI,1.19-2.99;P=0.007;hazard ratio,1.81;95%CI,1.14-2.87;P=0.012),as well as age and sex-adjusted Cox model in the propensity-score-matched cohort(hazard ratio,2.24;95%CI,1.22-4.12;P=0.01),HFreEF patients showed worse cardiovascular prognosis.Besides,HFreEF patients had worse or a trend to worse all-cause mortality in the models above.Conclusions:Hospitalized heart failure patients with recovered LVEF at discharge have different clinical characteristics and worse cardiovascular prognosis compared to those with consistently preserved LVEF.Part ?:The application of electrocardiogram in patients with heart failure or cardiomyopathyIn patients with heart failure or cardiomyopathy,abnormalities on the body surface 12-lead electrocardiogram(ECG)were very common.The ECG characteristics were of great significance for the assessment of cardiac structural changes and the degree of conduction system involvement,as well as identification of the primary disease.The PR interval and its related components,and left ventricular high voltage are common ECG indicators in patients with heart failure,but their application value still needs further exploration.Human interpretation of ECG has its limitations.The use of deep learning method maysignificantly improve the diagnostic performance of ECG in some circumstances,and it is still necessary to avoid its possible defects.This article will review the common features of ECG in patients with heart failure and cardiomyopathy,the reinterpretation of common findings including PR interval and its components as well as left ventricular high voltage,and the application of deep learning in the ECG of heart failure. |
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