Rize University Medical Faculty, Department of Cardiology, Rize, Turkey.
Scand Cardiovasc J. 2012 Apr;46(2):107-13. doi: 10.3109/14017431.2011.651485. Epub 2012 Jan 18.
Fragmented QRS complex (fQRS) is associated with increased morbidity and mortality, sudden cardiac death and recurrent cardiovascular events. However, its prognostic role has not been studied comprehensively in patients undergoing coronary artery bypass graft (CABG) surgery. In this study, we investigated the relationship between the presence of fQRS, and the prognostic markers and in-hospital major adverse cardiovascular events (MACE).
Two hundred and forty two eligible patients who underwent CABG surgery at our institution were enrolled consecutively. In analysis of fragmentations on electrocardiograms, presence of fQRS was defined as various RSR' patterns (≥ 1 R' or notching of S wave or R wave) with or without Q waves without a typical bundle-branch block in two contiguous leads corresponding to a major coronary artery territory. MACE was defined as cardiac death, recurrent myocardial infarction, heart failure, cerebrovascular event, sustained ventricular tachycardia or fibrillation.
Patients with fragmented QRS had older age (64 ± 10 vs. 61 ± 9 years, p = 0.03), prolonged QRS time (99 ± 11 vs. 87 ± 11 ms, p < 0.001), higher rate of Q wave on ECG (29% vs. 12%, p = 0.001), higher European system for cardiac operative risk evaluation (EUROSCORE) (4.0 ± 1.9 vs. 2.6 ± 1.6, p < 0.001) and lower left ventricular ejection fraction (LVEF)% (43 ± 12 vs. 60 ± 12, p < 0.001) in comparison to patients with non-fragmented QRS. In addition, the patients with fQRS had longer cross-clamp time (67 ± 23 vs. 55 ± 20 minutes, p = 0.001) and extracorporeal circulation (105 ± 31 vs. 91 ± 30 minutes, p = 0.003), increased inotropic usage (p < 0.001) and prolonged cardiac surgery intensive care unit (53 ± 25 vs. 35 ± 12 hours, p < 0.001) and in-hospital stay after CABG.
FQRS may have additional value in the assessment of cardiac function and in prediction of intra- and post-operative hemodynamic instability and adverse cardiovascular events. Fragmentations on admission ECG may be useful for identifying patients with higher risk who will need additional support after CABG surgery.
碎裂 QRS 波群（fQRS）与发病率和死亡率增加、心源性猝死和复发性心血管事件相关。然而，在接受冠状动脉旁路移植术（CABG）的患者中，其预后作用尚未得到全面研究。在这项研究中，我们研究了 fQRS 与预后标志物和院内主要不良心血管事件（MACE）之间的关系。
连续纳入在我院接受 CABG 手术的 242 名符合条件的患者。在心电图碎裂分析中，fQRS 的存在定义为两个相邻导联对应主要冠状动脉区域内存在各种 RSR' 模式（≥ 1 个 R'或 S 波切迹或 R 波）和/或 Q 波而无典型束支传导阻滞。MACE 定义为心脏死亡、复发性心肌梗死、心力衰竭、脑血管事件、持续性室性心动过速或颤动。
与非碎裂 QRS 组患者相比，fQRS 组患者年龄更大（64 ± 10 岁 vs. 61 ± 9 岁，p = 0.03），QRS 时间更长（99 ± 11 毫秒 vs. 87 ± 11 毫秒，p < 0.001），心电图上 Q 波的发生率更高（29% vs. 12%，p = 0.001），欧洲心脏手术风险评估系统（EUROSCORE）更高（4.0 ± 1.9 vs. 2.6 ± 1.6，p < 0.001），左心室射血分数（LVEF）%更低（43 ± 12 比 60 ± 12，p < 0.001）。此外，fQRS 患者的体外循环（ECMO）时间（67 ± 23 比 55 ± 20 分钟，p = 0.001）和体外循环时间（105 ± 31 比 91 ± 30 分钟，p = 0.003）更长，正性肌力药物的使用率更高（p < 0.001），体外循环后心脏手术重症监护病房（53 ± 25 比 35 ± 12 小时，p < 0.001）和住院时间更长。
fQRS 可能在评估心功能和预测术中及术后血流动力学不稳定和不良心血管事件方面具有额外价值。入院时心电图上的碎裂可能有助于识别风险较高的患者，这些患者在 CABG 手术后需要额外的支持。
