Department of Cardiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
Clin Cardiol. 2013 Sep;36(9):560-4. doi: 10.1002/clc.22158. Epub 2013 Jun 10.
Narrow fragmented QRS (fQRS) has recently been recognized as a significant predictor of prognosis in various cardiovascular diseases.
We hypothesized that the presence of narrow fQRS on admission electrocardiogram (ECG) in patients with decompensated systolic heart failure (HF) of any cause would be associated with long-term prognosis.
Patients hospitalized for decompensated HF due to ischemic or nonischemic dilated cardiomyopathy (left ventricular ejection fraction <35%) were retrospectively analyzed. The primary clinical end points were cardiovascular mortality, sudden cardiac death, and rehospitalization for HF.
The mean duration of follow-up was 3.73 ± 1.41 years. Patients were classified as fQRS(+) group (n = 114; mean age, 63.49 ± 12.04 years) and fQRS(-) group (n = 113 patients; mean age, 65.04 ± 11.95 years). fQRS on ECG was significantly correlated with New York Heart Association (NYHA) functional class (P = 0.001). In multivariate Cox proportional hazard analysis, narrow fQRS (odds ratio [OR]: 3.130, 95% confidence interval [CI]: 1.560-2.848, P = 0.001), chronic renal failure (OR: 2.455, 95% CI: 1.120-5.381, P = 0.025), NYHA class (OR: 8.305, 95% CI: 2.568-26.855, P < 0.0001), and hypoalbuminemia (OR: 2.099, 95% CI: 1.122-3.926, P = 0.020) were independent predictors of cardiovascular mortality. In Kaplan-Meier survival analysis, narrow fQRS on admission ECG predicted worse survival rate at 84 months; survival probability significantly decreased in the fQRS(+) group compared with fQRS(-) group (P < 0.0001).
Presence of narrow fQRS is associated with worse NYHA functional class in patients hospitalized for decompensated HF. Narrow fQRS predicts cardiovascular mortality in a specific subgroup of systolic HF patients, namely those hospitalized for decompensated HF of both ischemic and nonischemic causes.
窄 QRS 碎裂（fQRS）最近被认为是各种心血管疾病预后的重要预测指标。
我们假设，在任何原因导致的失代偿性收缩性心力衰竭（HF）患者入院时心电图（ECG）上出现窄 QRS，与长期预后相关。
回顾性分析因缺血性或非缺血性扩张型心肌病（左心室射血分数<35%）导致失代偿性 HF 住院的患者。主要临床终点是心血管死亡率、心源性猝死和因 HF 再住院。
平均随访时间为 3.73±1.41 年。患者分为 fQRS(+)组（n=114；平均年龄 63.49±12.04 岁）和 fQRS(-)组（n=113 例；平均年龄 65.04±11.95 岁）。ECG 上的 fQRS 与纽约心脏协会（NYHA）功能分级显著相关（P=0.001）。多变量 Cox 比例风险分析显示，窄 QRS（比值比[OR]：3.130，95%置信区间[CI]：1.560-2.848，P=0.001）、慢性肾功能衰竭（OR：2.455，95%CI：1.120-5.381，P=0.025）、NYHA 分级（OR：8.305，95%CI：2.568-26.855，P<0.0001）和低白蛋白血症（OR：2.099，95%CI：1.122-3.926，P=0.020）是心血管死亡率的独立预测因素。在 Kaplan-Meier 生存分析中，入院时 ECG 上的窄 QRS 预示着 84 个月时的生存率更差；fQRS(+)组的生存率明显低于 fQRS(-)组（P<0.0001）。
在因失代偿性 HF 住院的患者中，存在窄 QRS 与更差的 NYHA 功能分级相关。窄 QRS 预测缺血性和非缺血性病因导致的失代偿性 HF 患者亚组的心血管死亡率。
