碎裂QRS波群可以評價左心室致密化不全性心肌病患者的預(yù)后

翟正芹 唐閩 寧曉輝 陳柯萍 華偉 沙晶 張澍

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碎裂QRS波群可以評價左心室致密化不全性心肌病患者的預(yù)后

翟正芹 唐閩 寧曉輝 陳柯萍 華偉 沙晶 張澍

目的 碎裂QRS波群（fQRS）與多種心臟疾病患者的預(yù)后相關(guān)。然而，還未有fQRS與左心室致密化不全性心肌?。↙VNC）患者預(yù)后相關(guān)的研究。在不同研究中，LVNC患者的預(yù)后有很大差異，且缺乏簡單可行的用于評價預(yù)后的指標(biāo)。本研究旨在評估fQRS用于評價LVNC患者預(yù)后的價值。方法 回顧性分析64例LVNC患者。窄碎裂QRS波群（f-nQRS）：在至少2個相鄰心電圖導(dǎo)聯(lián)的R波或S波上出現(xiàn)1個或多個切跡，且QRS波群時限＜120 ms；寬碎裂QRS波群（f-wQRS）：在至少2個相鄰心電圖導(dǎo)聯(lián)的R波或S波上出現(xiàn)2個以上切跡，且QRS波群時限＞120 ms。結(jié)果 64例患者中，分別有24例（38%）患者的心電圖呈現(xiàn)f-nQRS，7例（11%）呈現(xiàn)f-wQRS。在隨訪期間，13例患者死亡，7例患者接受了心臟移植手術(shù)。Kaplan-Meier分析表明：f-nQRS組患者的生存率顯著低于非f-nQRS組患者的生存率（P=0.005）。同樣，f-wQRS組患者的生存率也明顯低于非f-wQRS組患者的生存率（P=0.02）。多因素分析表明：f-nQRS是預(yù)測LVNC患者全因死亡率的1個獨(dú)立指標(biāo)（HR：5.33；P=0.045）。結(jié)論 f-nQRS對于評價LVNC患者的預(yù)后具有重要價值，且可能提供1個有效方法用于對患者進(jìn)行危險度分層。

冠狀動脈；急性心肌梗塞；PCI；心室顫動

[ Abstract ] Objective Fragmented QRS complexes (fQRS) were proven to be associated with the prognosis of several heart diseases. However, no data is available regarding fQRS in left ventricular noncompaction cardiomyopathy (LVNC), in which the outcome varies greatly and a simple yet practicable prognostic predictor is needed. The purpose of this study was to determine the prognostic value of fQRS in LVNC patients. Methods Sixty-four LVNC patients were evaluated. Fragmented narrow QRS (f-nQRS) included single or multiple notches in the R or S wave in at least 2 contiguous electrocardiogram (ECG) leads and QRS duration ＜120 ms, fragmented wide QRS (f-wQRS) included more than 2 notches and QRS duration＞120 ms. Results f-nQRS and f-wQRS was present in 24 (38%) and 7 (11%) patients respectively. During follow-up, 13 patients died and 7 patients underwent heart transplantation. Kaplan-Meier analysis revealed that compared with the non-f-nQRS group, the f-nQRS group associated with a significantly lower survival (P=0.005). The f-wQRS group also demonstrated a substantially lower survival as compared with the non-f-wQRS group (P=0.02). Multivariate analysis indicated fnQRS was an independent predictor of all-cause mortality (HR: 5.33; P=0.045). Conclusions In LVNC patients, the presence of f-nQRS has significant prognostic value and may provide a valid method of risk stratification.

[ Key words ] coronary artery; PCI; ventricular fibrillation; Acute Myocardial Infarction. ST-Elevation Myocardial Infarction

左心室致密化不全性疾?。↙VNC）是一種較為罕見的心臟病[1-6]。LVNC患者以左心室肌小梁異常粗大、小梁間隙深陷，增厚心肌可分為2個不同層次（薄的致密化層和厚的未致密化層）為特征[1]。在不同研究中，LVNC患者的預(yù)后有很大差異，LVNC患者在隨訪期間的死亡率為2%～47%[6-8]。

碎裂QRS波群（fQRS）是近年來引起廣泛關(guān)注的無創(chuàng)性心電診斷指標(biāo)，它定義為在12導(dǎo)聯(lián)靜息心電圖呈現(xiàn)不同類型RSR'波且出現(xiàn)切跡的QRS波群[9-18]?！?br>