Kalahasti Vidyasagar, Nambi Vijay, Martin David O, Lam Cathy T, Yamada David, Wilkoff Bruce L, Niebauer Mark J, Jaeger Fredrick J, Tchou Patrick J, Chung Mina K
Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Am J Cardiol. 2003 Oct 1;92(7):798-803. doi: 10.1016/s0002-9149(03)00886-5.
This study tested the hypothesis that prolonged QRS duration independently predicts long-term mortality in patients who underwent risk stratification and treatment for ventricular arrhythmias. Patients who underwent risk stratification by electrophysiologic study were identified. Electrophysiologic study results were defined as positive if sustained monomorphic ventricular tachycardia was induced. Mortality was the primary end point. Of 915 patients studied, mean left ventricular (LV) ejection fraction (EF) was 35.3 +/- 15.7%, 608 (66.4%) had coronary artery disease, 233 (25.5%) had positive electrophysiologic study findings, 298 (32.6%) received implantable cardioverter-defibrillators, and 174 (19%) died (mean follow-up 35.0 +/- 15.0 months). Cox regression analysis identified older age, coronary artery disease, digoxin use, absence of beta blockers, lower LVEF, and prolonged QRS duration to be independent predictors of mortality. QRS duration > or =130 ms, present in 33.6% of patients, was associated with a twofold increase in mortality (hazard ratio 2.1, 95% confidence interval 1.5 to 2.8; p <0.0001). For every 10 ms increase in QRS duration, mortality rate increased 10%. In a subgroup of patients with coronary artery disease and LVEF < or =30%, prolonged QRS duration remained an independent predictor of mortality (hazard ratio 2.6, 95% confidence interval 1.6 to 4.2; p <0.0001). Thus, prolonged QRS duration is a strong independent marker of long-term mortality in patients who undergo risk stratification for ventricular arrhythmias. Whether QRS duration represents only a marker for mortality or if modification of this factor using resynchronization therapies will impact mortality merits further study.
在接受室性心律失常风险分层和治疗的患者中，QRS时限延长可独立预测长期死亡率。确定了通过电生理研究进行风险分层的患者。如果诱发了持续性单形性室性心动过速，则电生理研究结果定义为阳性。死亡率是主要终点。在研究的915例患者中，平均左心室（LV）射血分数（EF）为35.3±15.7%，608例（66.4%）患有冠状动脉疾病，233例（25.5%）电生理研究结果为阳性，298例（32.6%）接受了植入式心脏复律除颤器，174例（19%）死亡（平均随访35.0±15.0个月）。Cox回归分析确定年龄较大、冠状动脉疾病、使用地高辛、未使用β受体阻滞剂、较低的左心室射血分数和QRS时限延长是死亡率的独立预测因素。QRS时限≥130 ms存在于33.6%的患者中，与死亡率增加两倍相关（风险比2.1，95%置信区间1.5至2.8；p<0.0001）。QRS时限每增加10 ms，死亡率增加10%。在冠状动脉疾病且左心室射血分数≤30%的患者亚组中，QRS时限延长仍然是死亡率的独立预测因素（风险比2.6，95%置信区间1.6至4.2；p<0.0001）。因此，QRS时限延长是接受室性心律失常风险分层患者长期死亡率的一个强有力的独立标志物。QRS时限是否仅代表死亡率的一个标志物，或者使用再同步治疗改变这一因素是否会影响死亡率，值得进一步研究。
