Analysis of the differences in ventricular repolarization indices on electrocardiogram among chronic heart failure patients with different cardiac function grades and their correlation with prognosis

GE Qing-yun; CHENG Wei-xin

doi:10.3969/j.issn.1672-5301.2025.07.010

Abstract：Objective To investigate the differences in electrocardiographic indices of ventricular repolarization and their correlation with prognosis in patients with chronic heart failure(CHF)of different cardiac function classifications.Methods One hundred and seventy cases of CHF patients admitted to Nanjing Jiangning Hospital from January 2019 to January 2022 were retrospectively included,which were categorized into class Ⅱ(60 cases),classⅢ(62 cases),and classⅣ(48 cases)groups according to the cardiac function grading of the New York Heart Association(NYHA)of the United States,and 150 healthy medical checkups during the same period of time were selected as the control group.To compare the clinical data of CHF patients with different cardiac function classifications and the electrocardiographic ventricular repolarization indices[T-wave peak-to-terminal interval(Tp-e),interval from the beginning of the QRS wave cluster to the end of the T-wave(QT),Tp-e/QT,T-wave peak-to-terminal interval dispersion(Tp-ed),heart rate-corrected QT interval(QTc),QT interval dispersion(QTd),and the Tp-e to QTc ratio(Tp-e/QTc)]differences.After 1 year of follow-up after discharge,CHF patients were divided into a good prognosis(no recurrence)group(131 cases)and a poor prognosis(recurrence)group(39 cases)according to the recurrence of the disease,comparing the clinical data and electrocardiogram ventricular repolarization indexes of the 2 groups,and analyzing the correlation between the electrocardiogram ventricular repolarization indexes and prognosis,as well as their predictive value of the prognosis of CHF patients.Results The levels of electrocardiographic indices of ventricular repolarization(Tp-e,Tp-e/QT,Tp-ed,QTc,QTd,and Tp-e/QTc)were significantly higher in patients with CHF in the classⅢandⅣgroups compared to the classⅡgroup(P<0.05),and in the class Ⅳ group significantly higher than in the class Ⅲ group(P<0.05).The levels of electrocardiographic indices of ventricular repolarization(Tp-e,Tp-e/QT,Tp-ed,QTc,QTd,Tp-e/QTc)were significantly higher in patients in the group with poor prognosis than in the group with good prognosis(P<0.05).Spearman correlation analysis showed that electrocardiographic indices of ventricular repolarization(Tp-e,Tp-e/QT,Tp-ed,QTc,QTd,Tp-e/QTc)Tp-e was positively correlated with poor prognosis in patients with CHF(r=0.704,0.582,0.549,0.457,0.603,0.501,P<0.001).The ROC results showed that the combined prediction of the six ECG ventricular repolarization indices(Tp-e,Tp-e/QT,Tp-ed,QTc,QTd,Tp-e/QTc)had an AUC of 0.960,a sensitivity of 87.18%,and a specificity of 93.89%,which was higher than that of Tp-e(Z=3.236,P=0.001),Tp-e/QT(Z=3.527,P<0.001),Tp-ed(Z=3.328,P=0.001),QTc(Z=4.462,P<0.001),QTd(Z=3.757,P<0.001),and Tp-e/QTc(Z=3.204,P<0.001)individually predicted.The results of multifactorial logistic regression model analysis showed that NYHA cardiac function class,coronary artery disease,Tp-e,Tp-e/QT,Tp-ed,QTc,and QTd were independent risk factors affecting the prognosis of patients with CHF(P<0.05).Conclusion The electrocardiogram ventricular repolarization indices Tp-e,Tp-e/QT,Tp-ed,QTc,QTd and Tp-e/QTc are significantly elevated in CHF patients and positively correlated with poor prognosis,providing reference value for prognosis assessment in these patients.