الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
HF is a global term for the physiological state in which cardiac output is insufficient in meeting the needs of the body and lungs.
Advances in the treatment of coronary artery diseases and acute ischemic syndromes, which have saved lives, have resulted in a growing population of survivors with left ventricular dysfunction who are destined to develop the heart failure syndrome.
ECG is a widely available tool that has a prognostic value in HF. It is relatively inexpensive, simple to perform, and yields an instant result. The measurement is objective and does not require specialized training to interpret.
This prospective study is designed to determine whether ECG conveys prognostic and diagnostic Information in patients with HF.
The study included 100 patients, presented to the Emergency unit at the Alexandria main university hospital with acute, or decompensated chronic, heart failure were admitted to the cardiology department.
Exclusion criteria:
• Patients with aortic stenosis.
• Patients with mitral stenosis.
• Left ventericular outflow tract obstruction (e.g. HOCM).
• Atrial Fibrillation (AF).
All patients were subjected to thorough history taking and clinical examination, and standard 12 lead ECG. The sums of the amplitudes of the 6 limb leads, 6 chest leads, and total 12 leads were calculated at admission, discharge, and at 3 months of the follow up. Transthoracic Echocardiography (at discharge and at 3 months follow up), 6MWT (at discharge and at 3 months follow up) were performed to all patients. All patients were subjected to 3 months of follow up as regard NYHA functional classification, rehospitalization, and death.
The patients were divided retrospectively into 2 groups: those who showed clinical improvement and required no re-hospitalization (non re-hospitalized group) or (NRG), and those who deteriorated and required further hospitalization (re-hospitalized group) or (RG). The former included 66 patients, while the later included 34.
The study included 75 males and 25 females, aged between 21 and 86 years (mean = 59.14 ± 13.41 years).
Nine patients (9%) had AHF, while (91%) had previously been diagnosed as patients with CHF, with a mean duration of 3.48 ± 2.72 years (range = 3 months – 11 years). Decompensation occurred due to acute coronary syndrome in 47%, chest infection in 14%, non-compliance to therapy in 11%, uncontrolled hypertension in 10%, arrhythmias in 9%, anemia in 5%, intake of negative inotropic drugs in 3%, or thyrotoxicosis in 1%.
As regard the 6MWT, NRG were able to walk for 50-490 m at discharge (mean = 320.08 ± 96.18). At follow-up, these distances significantly increased (P 0.001), ranging between 100-500 m (mean = 342.58 ± 89.89). Contrary to these findings RG could walk a significantly shorter distance at discharge ranging between 50 – 440 m (mean = 208.18 ± 110.83). At follow-up, this distance significantly decreased (P 0.001), ranging between 30-390 m (mean=156.87 ± 98.55).
There was a significant increase in LVEDD and LVESD with an insignificant increase in the EF when studying the whole population. However, in the NRG, there was no significant difference in the LVEDD and LVESD compared at discharge and at follow-up (P= 0.06, 0.051 respectively), but there was significant difference in EF compared at discharge and at follow-up (P = 0.03). As regards the RG, there was a significant increase in both LVEDD and LVESD and a significant decrease in EF% (P <0.001 for all).
When studying all patients and NRG, the three voltage parameters (total QRS voltage, limb leads voltage and chest leads voltage) all significantly increased from admission to discharge values (p <0.001 for all). Also, the significant increase continued at follow-up (p <0.001 for all).
Different results were obtained when studying RG. The three voltage parameters significantly increased from admission to discharge value (p <0.001 for all). whereas, there was a significant decrease in the three voltage parameters at follow-up (p <0.001, 0.002, <0.001 respectively).
The QRS voltage in the chest leads was found to be well correlated with the left ventricular end systolic dimension (LVESD) and with the left ventricular end diastolic dimension (LVEDD) before discharge and at the 3 months follow up visit, unlike the limb leads that did not show correlation with neither the LVESD nor the LVEDD. Contrary to these findings a significant inverse relationship was found between the presence of PERED and the limbs leads voltage but not with chest leads voltages.
We concluded that there is a close relation between ECG voltage and both PERED and LV dimensions. The change in ECG voltage can provide important diagnostic and prognostic information in patients with acute or decompensated HF. If the detection and monitoring of the ECG voltage changes incorporated in the clinician’s ”routine”, considerable improvements in the care of patients with CHF may be realized.