Madias John E
Division of Cardiology, Elmhurst Hospital Center, NY 11373, USA.
J Electrocardiol. 2005 Jan;38(1):54-7. doi: 10.1016/j.jelectrocard.2004.09.009.
Patients with congestive heart failure (CHF) responding to diuresis reveal marked augmentation of the QRS complexes (AUG-QRS) in their electrocardiograms (ECGs). Recently, such change in the ECG has been observed in patients with anasarca (AN) of varying etiology commensurate with partial alleviation of the volume overload; similar ECG change has been noted in patients with end-stage renal failure after hemodialysis. The mechanism for the AUG-QRS in patients with CHF has been debated, and many have ascribed this ECG change to the "Brody effect," linking the AUG-QRS to reduction of intracardiac blood volumes resulting from diuresis. However, the Brody effect (a theoretical formulation not fully validated by experimentation and associated with controversy in its clinical implementation) has not provided a satisfactory explanation for the AUG-QRS in patients with CHF. In contrast, the described association between amelioration of AN in a diverse patient population and AUG-QRS suggests that this ECG change in patients with CHF is due to an increased electrical resistance of the passive body volume conductor, resulting from water loss effected by diuresis. This thesis is supported by theoretical work, animal experimentation, and clinical evidence.
充血性心力衰竭（CHF）患者在利尿治疗有反应时，其心电图（ECG）显示QRS波群明显增大（AUG-QRS）。最近，在不同病因的全身性水肿（AN）患者中也观察到了这种心电图变化，这与容量超负荷的部分缓解相对应；在血液透析后的终末期肾衰竭患者中也注意到了类似的心电图变化。CHF患者出现AUG-QRS的机制一直存在争议，许多人将这种心电图变化归因于“布罗迪效应”，将AUG-QRS与利尿导致的心内血容量减少联系起来。然而，布罗迪效应（一种尚未通过实验完全验证且在临床应用中存在争议的理论表述）并未对CHF患者的AUG-QRS提供令人满意的解释。相比之下，在不同患者群体中AN改善与AUG-QRS之间的上述关联表明，CHF患者的这种心电图变化是由于利尿导致的水分流失，使被动身体容积导体的电阻增加所致。这一论点得到了理论研究、动物实验和临床证据的支持。
