Grothoff M, Spors B, Abdul-Khaliq H, Abd El Rahman M, Alexi-Meskishvili V, Lange P, Felix R, Gutberlet M
Department of Radiology and Nuclear Medicine, Charité, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
Clin Res Cardiol. 2006 Dec;95(12):643-9. doi: 10.1007/s00392-006-0440-5. Epub 2006 Oct 10.
QRS prolongation is a negative prognostic factor for the development of ventricular arrhythmia after repair of tetralogy of Fallot (TOF). In this MRI study, we performed a multivariate analysis to determine the influence of volumetric and functional parameters as well as time factors on QRS duration.
Sixty-seven patients after surgical repair of TOF were studied using a 1.5T MRI. Measurement of the ventricles was performed with a multislice-multiphase sequence. Left and right ventricular volumes, ejection fractions (EF) and myocardial masses were determined. Pulmonary regurgitant fraction (PRF) was quantified by velocity encoded flow measurement in the main pulmonary artery. Maximum QRS duration was taken from a 12-channel ECG. Mean maximum QRS duration was 132 ms (+/- 29 ms). Mean PRF was 29.2% (+/- 13.4%). QRS duration correlated significantly with PRF (r = 0.49; p < 0.01; n = 54) and with right ventricular enddiastolic volume index (RVEDVI) (r = 0.29; p < 0.05; n = 67). Multivariate analysis revealed that the combination of PRF, postoperative period, age at surgical repair, and left ventricular (LV) enddiastolic volume are correlated with QRS prolongation.
In patients after repair of TOF, pulmonary regurgitation is related to QRS prolongation. Furthermore, even LV size plays a role in the enlargement of the QRS complex.
QRS波增宽是法洛四联症（TOF）修复术后发生室性心律失常的不良预后因素。在这项MRI研究中，我们进行了多因素分析，以确定容积和功能参数以及时间因素对QRS波时限的影响。
对67例TOF手术修复后的患者使用1.5T MRI进行研究。采用多层多期序列测量心室。测定左、右心室容积、射血分数（EF）和心肌质量。通过主肺动脉的速度编码血流测量对肺反流分数（PRF）进行定量。从12导联心电图获取最大QRS波时限。平均最大QRS波时限为132毫秒（±29毫秒）。平均PRF为29.2%（±13.4%）。QRS波时限与PRF显著相关（r = 0.49；p < 0.01；n = 54），与右心室舒张末期容积指数（RVEDVI）也显著相关（r = 0.29；p < 0.05；n = 67）。多因素分析显示，PRF、术后时间、手术修复时的年龄以及左心室（LV）舒张末期容积的组合与QRS波增宽相关。
在TOF修复术后的患者中，肺反流与QRS波增宽有关。此外，即使左心室大小也在QRS波群增宽中起作用。
