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法洛四联症根治术后成人碎裂 QRS 波与延迟钆增强心脏磁共振检测右心室纤维化的关系。

Relation of fragmented QRS complex to right ventricular fibrosis detected by late gadolinium enhancement cardiac magnetic resonance in adults with repaired tetralogy of fallot.

机构信息

Department of Internal Medicine, Cardiovascular Imaging Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

出版信息

Am J Cardiol. 2012 Jan 1;109(1):110-5. doi: 10.1016/j.amjcard.2011.07.070. Epub 2011 Sep 29.

Abstract

Fragmented QRS (fQRS) on 12-lead electrocardiography reflects conduction delay caused by myocardial fibrosis and dysfunction. Ventricular fibrosis detected by late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) is reportedly correlated with worse clinical outcomes in adults with repaired tetralogy of Fallot (TOF). The aim of this study was to assess whether the presence of fQRS is associated with right ventricular (RV) fibrosis or dysfunction in this patient group. In 37 consecutive patients (median age 30 years, median age at repair 6.6 years), the number of leads showing fQRS, defined as the presence of >2 notches on the R/S wave in ≥2 contiguous leads, was counted. RV systolic function, dilatation, and LGE score were measured using LGE CMR. Ventricular LGE was observed mainly at the previous surgical sites: the RV outflow tract (33 of 37), ventricular septal defect patch region (15 of 37), and RV anterior wall (11 of 37). Fragmented QRS was found mostly in the right and mid precordial leads. The fQRS group (n = 20) demonstrated higher RV LGE scores (p <0.001) and lower RV ejection fractions (p = 0.02) and a trend toward larger RV end-diastolic and end-systolic volumes (p = 0.12 and p = 0.06, respectively) compared to the non-fQRS group (n = 17). The number of electrocardiographic leads showing fQRS was positively correlated with RV LGE score (r = 0.75, p <0.001). The presence of fQRS remained independently associated with the presence of supramedian RV LGE score, even after adjusting for relevant parameters. In conclusion, fQRS was closely associated with more extensive RV fibrosis and dysfunction in adults with repaired tetralogy of Fallot.

摘要

心电图上的碎裂 QRS(fQRS)反映了心肌纤维化和功能障碍引起的传导延迟。据报道,心脏磁共振(CMR)延迟钆增强(LGE)检测到的心室纤维化与修复后的法洛四联症(TOF)成年患者的临床预后较差相关。本研究旨在评估 fQRS 是否与该患者群体的右心室(RV)纤维化或功能障碍有关。在 37 例连续患者(中位数年龄 30 岁,修复时中位数年龄 6.6 岁)中,计算出现 fQRS 的导联数,定义为≥2 个连续导联上 R/S 波存在>2 个切迹。使用 LGE CMR 测量 RV 收缩功能、扩张和 LGE 评分。心室 LGE 主要观察到先前手术部位:RV 流出道(37 例中的 33 例)、室间隔缺损补丁区域(37 例中的 15 例)和 RV 前壁(37 例中的 11 例)。fQRS 主要见于右胸导联和中胸导联。与非 fQRS 组(n=17)相比,fQRS 组(n=20)的 RV LGE 评分更高(p<0.001),RV 射血分数更低(p=0.02),RV 舒张末期和收缩末期容积更大(p=0.12 和 p=0.06,分别)。心电图上出现 fQRS 的导联数与 RV LGE 评分呈正相关(r=0.75,p<0.001)。即使在调整了相关参数后,fQRS 的存在仍然与 RV 中值以上 LGE 评分的存在独立相关。总之,fQRS 与修复后的法洛四联症成年患者更广泛的 RV 纤维化和功能障碍密切相关。

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