【摘要】 目的 探讨器质性心血管病住院患者左心衰竭（心衰）与无心衰在心电图“掉头”现象上存在的差异。方法 本研究为多中心横断面研究的子研究。纳入2017年11月1日至2020年1月31日于6家医院心血管内科收治的器质性心血管病患者。筛除不符合条件的病例后，统计具有心电图掉头特征的病例数，根据入院诊断分为掉头心衰组与掉头无心衰组。对具有掉头特征的心电图观察指标包括V₁导联P波终末电势（PTFV₁）<-0.02 mm·s、ST-T改变或坏死性Q波、各种心律失常、至少一个导联QRS波挫折或碎裂波、掉头迟钝以及QRS波群时限，比较各心电指标在掉头心衰组与掉头无心衰组发生率或中位数是否存在统计学差异。结果 排除不符合条件的患者，经调查具有心电图掉头特征的病例532例，其中掉头心衰组417例（占78.4%,417/532），掉头无心衰组115例（占21.6%,115/532）。掉头心衰组与掉头无心衰组比较，多项心电指标差异具有统计学意义：PTFV₁<-0.02 mm·s（71.1%比17.1%，χ²=96.168）,ST-T改变或坏死性Q波（89.2%比51.3%，χ²=84.202），各种心律失常（54.4%比25.2%，χ²=30.827），至少一个导联QRS波挫折或碎裂波（44.8%比26.1%，χ²=13.131），均P<0.001;QRS波群时限（Z=-4.558,P<0.001）差异亦具有统计学意义。掉头迟钝（22.5%比14.8%，χ²=3.287,P=0.070）及掉头波动态改变（χ²=0.002,P=0.964）的发生率在两组间差异无统计学意义。结论 在心电图表现为“掉头”现象的器质性心血管病住院患者中，合并左心衰竭者其PTFV₁异常、ST-T改变或坏死性Q波、心律失常及QRS波挫折/碎裂波的发生率以及QRS时限均显著高于不伴心衰患者。更多还原

【Abstract】 Objective To investigate the differences in the electrocardiographic "U-turn" phenomenon between hospitalized patients with structural heart disease and with versus without left heart failure（HF）. Methods In this multicenter, cross-sectional sub-study, consecutive patients with structural heart disease were enrolled from six cardiology departments（November 1, 2017, to January 31, 2020）. Patients exhibiting the "U-turn" feature were categorized into HF and non-HF groups. ECGs were analyzed for: PTFV₁ <-0.02 mm·s, ST-T changes or pathological Q waves, arrhythmias, notched/fragmented QRS complexes, "U-turn" slow-down, and QRS duration. Intergroup comparisons were performed for the incidence or median values of these parameters. Results Of 532 eligible patients with the "U-turn" feature, 417（78.4%） had HF and 115（21.6%） did not. Significant intergroup differences（all P<0.001） were found in: PTFV₁ <-0.02 mm·s（71.1% vs. 17.1%; χ2=96.168）, ST-T/pathological Q waves（89.2% vs. 51.3%; χ2=84.202）, arrhythmias（54.4% vs. 25.2%; χ2=30.827）, and notched/fragmented QRS（44.8% vs. 26.1%; χ2=13.131）. QRS duration also differed significantly（Z=-4.558, P<0.001）. Incidences of "Uturn slow-down"（22.5% vs. 14.8%; χ2 =3.287, P=0.070） and "U-turn" wave dynamic changes（χ2 =0.002, P=0.964） were not significantly different. Conclusions Among hospitalized patients with structural heart disease who exhibit the electrocardiographic "U-turn" phenomenon, the prevalence of PTFV₁ abnormality, ST-T changes or pathological Q waves, arrhythmias, notched/fragmented QRS complexes, as well as the QRS duration, are all significantly higher in those with concurrent HF than in those without.更多还原