Sha Jing, Zhang Shu, Tang Min, Chen Keping, Zhao Xinran, Wang Fangzheng
Center for Arrhythmia Diagnosis and Treatment, Fu Wai Cardiovascular Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Ann Noninvasive Electrocardiol. 2011 Jul;16(3):270-5. doi: 10.1111/j.1542-474X.2011.00442.x.
Several studies have showed that fragmented QRS complexes (f - QRS, defined as different RSR' patterns) on a routine 12 - lead electrocardiogram were associated with increased mortality and arrhythmic events in patients with coronary artery disease, but relatively little data were available regarding idiopathic dilated cardiomyopathy (IDCM).
The purpose of this study was to evaluate the relationship between fragmentation of QRS and the combined end point of all-cause mortality and ventricular arrhythmias in patients with IDCM.
One hundred twenty-eight patients with IDCM and left ventricular dysfunction (ejection fraction, EF ≤ 40%) were analyzed, respectively. According to QRS duration and the existence of f - QRS on 12-lead electrocardiograph (ECG), the study populations were divided into three groups: (1) the f - QRS group (QRS <120 ms and with fragmented QRS, n = 51), (2) the wide QRS (wQRS) group (QRS ≥ 120 ms, n = 48), and (3) the nonfragmented QRS (non-fQRS) group (QRS < 120 ms and without f - QRS, n = 29).
During a mean follow-up of 14 ± 5 months, 25 (19.5%) patients had deaths and ventricular arrhythmic events. The combined end point of all-cause mortality and ventricular tachyarrhythmias was significantly higher in the f - QRS and wQRS groups than the non-fQRS group (23.5%, 25%, and 3.4%, respectively; P < 0.05 for both). Event-free was significantly decreased in the f - QRS group versus the non-fQRS group (P = 0.02). Univaritae regression analysis revealed that f - QRS was a stronger predictor of mortality and arrhythmic events in IDCM patients.
f - QRS on 12-lead ECG has a high predictive value for the combined end point of all-cause mortality and ventricular tachyarrhythmias in IDCM patients with left ventricular dysfunction.
多项研究表明，常规12导联心电图上的碎裂QRS波群（f-QRS，定义为不同的RSR'型）与冠心病患者死亡率增加及心律失常事件相关，但关于特发性扩张型心肌病（IDCM）的数据相对较少。
本研究旨在评估IDCM患者QRS波群碎裂与全因死亡率和室性心律失常联合终点之间的关系。
分别分析了128例IDCM伴左心室功能不全（射血分数，EF≤40%）的患者。根据12导联心电图（ECG）上的QRS波群时限及f-QRS的存在情况，将研究人群分为三组：（1）f-QRS组（QRS＜120 ms且伴有碎裂QRS波群，n = 51），（2）宽QRS波群（wQRS）组（QRS≥120 ms，n = 48），（3）非碎裂QRS波群（non-fQRS）组（QRS＜120 ms且无f-QRS，n = 29）。
在平均14±5个月的随访期间，25例（19.5%）患者发生死亡和室性心律失常事件。f-QRS组和wQRS组全因死亡率和室性快速心律失常的联合终点显著高于non-fQRS组（分别为23.5%、25%和3.4%；两组P均＜0.05）。f-QRS组与non-fQRS组相比无事件生存率显著降低（P = 0.02）。单因素回归分析显示，f-QRS是IDCM患者死亡率和心律失常事件的更强预测因子。
12导联ECG上的f-QRS对左心室功能不全的IDCM患者全因死亡率和室性快速心律失常联合终点具有较高的预测价值。
