Das Mithilesh Kumar, Saha Chandan, El Masry Hicham, Peng Jonathan, Dandamudi Gopi, Mahenthiran Jo, McHenry Paul, Zipes Douglas P
Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
Heart Rhythm. 2007 Nov;4(11):1385-92. doi: 10.1016/j.hrthm.2007.06.024. Epub 2007 Aug 1.
Fragmented QRS (fQRS) on a 12-lead electrocardiogram (ECG) is associated with myocardial scar in patients with coronary artery disease (CAD).
We postulated that fQRS is a predictor of cardiac events and mortality in patients who have known CAD or who are being evaluated for CAD.
The cardiac events (myocardial infarction, need for revascularization, or cardiac death) and all-cause mortality were retrospectively reviewed in 998 patients (mean age 65.5 +/- 11.9 years, male 967) who underwent nuclear stress test. The fQRS on a 12-lead ECG included various RSR' patterns (> or =1 R' prime or notching of S wave or R wave) without typical bundle branch block in 2 contiguous leads corresponding to a major coronary artery territory.
All-cause mortality (93 [34.1%] vs 188 [25.9%]) and cardiac event rate (135 [49.5%] vs 200 [27.6%]) were higher in the fQRS group compared with the non-fQRS group during a mean follow-up of 57 +/- 23 months. A Kaplan-Meier survival analysis revealed significantly lower event-free survival for cardiac events (P <.001) and all-cause mortality (P = .02). Multivariate Cox regression analysis revealed that significant fQRS was an independent significant predictor for cardiac events but not for all-cause mortality. The Kaplan-Meier survival analysis showed no significant difference between fQRS and Q waves groups for cardiac events (P = .48) and all-cause mortality (P = .08).
The fQRS is an independent predictor of cardiac events in patients with CAD. It is associated with significantly lower event-free survival for a cardiac event on long-term follow-up.
12导联心电图（ECG）上的碎裂QRS波（fQRS）与冠状动脉疾病（CAD）患者的心肌瘢痕相关。
我们推测fQRS是已知患有CAD或正在接受CAD评估的患者发生心脏事件和死亡的预测指标。
回顾性分析998例接受核素负荷试验的患者（平均年龄65.5±11.9岁，男性967例）的心脏事件（心肌梗死、血运重建需求或心源性死亡）和全因死亡率。12导联ECG上的fQRS包括各种RSR′形态（≥1个R′波或S波或R波切迹），且在对应主要冠状动脉区域的2个相邻导联中无典型束支传导阻滞。
在平均57±23个月的随访期间，fQRS组的全因死亡率（93例[34.1%]对188例[25.9%]）和心脏事件发生率（135例[49.5%]对200例[27.6%]）均高于非fQRS组。Kaplan-Meier生存分析显示，心脏事件（P<.001）和全因死亡率（P=.02）的无事件生存率显著降低。多因素Cox回归分析显示，显著的fQRS是心脏事件的独立显著预测指标，但不是全因死亡率的预测指标。Kaplan-Meier生存分析显示，fQRS组和Q波组在心脏事件（P=.48）和全因死亡率（P=.08）方面无显著差异。
fQRS是CAD患者心脏事件的独立预测指标。在长期随访中，它与心脏事件的无事件生存率显著降低相关。
