Das Mithilesh K, Zipes Douglas P
Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
Heart Rhythm. 2009 Mar;6(3 Suppl):S8-14. doi: 10.1016/j.hrthm.2008.10.019. Epub 2008 Oct 17.
Several invasive and noninvasive tests for risk stratification of sudden cardiac death have been studied, mostly in the context of structural heart disease such as coronary artery disease (CAD), cardiomyopathy, and heart failure. Tests such as MTWA (repolarization abnormality) and SAECG (depolarization abnormality) have high negative predictive values but a low positive predictive value in patients with myocardial infarction or cardiomyopathy. Recently, we described the presence of a fragmented QRS complexes (fQRS) on a routine 12-lead electrocardiogram as another marker of depolarization abnormality. fQRS represents conduction delay caused by myocardial scar in patients with CAD. However, fQRS is not specific for CAD and is also encountered in other myocardial diseases such as cardiomyopathy and congenital heart disease. fQRS is associated with increased mortality and arrhythmic events in patients with CAD. fQRS has also been defined as a marker of arrhythmogenic right ventricular dysplasia/cardiomyopathy and Brugada syndrome. In Brugada syndrome, the presence of fQRS predicts episodes of ventricular fibrillation during follow-up. Therefore, the utility of fQRS in risk stratification of sudden cardiac death needs to be explored further, especially in nonischemic cardiomyopathy and heart failure.
已经对几种用于心脏性猝死风险分层的侵入性和非侵入性检查进行了研究，大多是在诸如冠状动脉疾病（CAD）、心肌病和心力衰竭等结构性心脏病的背景下。诸如微伏级T波电交替（MTWA，复极异常）和信号平均心电图（SAECG，去极化异常）等检查在心肌梗死或心肌病患者中具有较高的阴性预测价值，但阳性预测价值较低。最近，我们描述了常规12导联心电图上碎裂QRS波群（fQRS）的存在是去极化异常的另一个标志。fQRS代表CAD患者心肌瘢痕引起的传导延迟。然而，fQRS并非CAD所特有，在其他心肌疾病如心肌病和先天性心脏病中也可出现。fQRS与CAD患者死亡率增加和心律失常事件相关。fQRS也已被定义为致心律失常性右室发育不良/心肌病和Brugada综合征的一个标志。在Brugada综合征中，fQRS的存在可预测随访期间的心室颤动发作。因此，fQRS在心脏性猝死风险分层中的效用需要进一步探索，尤其是在非缺血性心肌病和心力衰竭中。
