12 导联心电图碎裂 QRS 波对急性心肌梗死患者的预后价值。
Prognostic value of fragmented QRS on a 12-lead ECG in patients with acute myocardial infarction.
机构信息
Department of Cardiology, University Hospital, Dijon, France.
出版信息
Heart Lung. 2013 Sep-Oct;42(5):326-31. doi: 10.1016/j.hrtlng.2013.05.005. Epub 2013 Jul 11.
OBJECTIVE
To investigate the determinants and the prognostic value of fragmented QRS (fQRS) after AMI.
PATIENTS AND METHODS
Prospective cohort of 307 consecutive patients with AMI.
MAIN OUTCOMES MEASURED
MACE (death plus non-fatal recurrent MI), hospitalization for an episode of heart failure, ventricular arrhythmia (VT or VF) at two years follow-up.
RESULTS
On the serial 12-lead ECG recorded during the in-hospital stay, 162 (53%) had no fQRS (no fQRS group). 145 (47%) presented an fQRS, which was persistent in 108 (34%) patients (persistent fQRS group) and transient in 37 (12%) patients (transient fQRS group). Patients with a fragmented QRS (transient or persistent) were older, more likely to be hypertensive and less likely to be smokers than were patients without fQRS. By multivariate logistic regression analysis, only hypertension (OR (95% CI): 1.66 (1.00-2.74); p = 0.047) was associated with an fQRS. During a mean follow-up of 846 ± 297 days, there were 82 MACE recorded: 17 patients died from a CV cause (10% event rate) among patients without fQRS, 22 (20% event rate) among patients with persistent fQRS and 3 (8% event rate) among patients with transient fQRS. Similarly, non-fatal recurrent MI occurred more frequently in patients with fQRS (18 (16%) and 10 (27%)) for persistent and transient fQRS, respectively, vs. 16 (10%) in the no fQRS group (p = 0.019). However, the occurrence of heart failure symptoms and ventricular arrhythmia was not significantly different (p = 0.162 and p = 0.242, respectively). Survival analysis by the Kaplan-Meier method showed a significant difference (log rank p = 0.026) between groups, and only persistent fQRS was associated with decreased survival. In multivariate cox regression analysis, the GRACE score, blood glucose on admission, and B-blockers in the acute phase were independent predictors of MACE at two years. fQRS was not a significant independent predictor of MACE (HR (95% CI): 1.57 (0.95-2.60); p = 0.08). Moreover, fQRS was not a predictor of heart failure or ventricular arrhythmia in univariate analysis.
CONCLUSIONS
Persistent fQRS on a 12-lead ECG is a marker of decreased survival after AMI, whereas transient fQRS correlates with recurrent MI.
目的
探讨 AMI 后碎裂 QRS （fQRS）的决定因素及其预后价值。
方法
前瞻性连续纳入 307 例 AMI 患者。
主要观察指标
主要不良心血管事件（MACE，死亡和非致命性复发性 MI）、因心力衰竭住院、随访 2 年时出现室性心律失常（VT 或 VF）。
结果
在住院期间连续记录的 12 导联心电图上，162 例（53%）无 fQRS（无 fQRS 组）。145 例（47%）出现 fQRS，其中 108 例（34%）为持续性 fQRS（持续性 fQRS 组），37 例（12%）为一过性 fQRS（一过性 fQRS 组）。与无 fQRS 患者相比，有碎裂 QRS（持续性或一过性）的患者年龄更大，更可能患有高血压，且更不可能吸烟。多变量 logistic 回归分析显示，仅高血压（OR（95%CI）：1.66（1.00-2.74）；p=0.047）与 fQRS 相关。在平均 846±297 天的随访期间，记录到 82 例 MACE：无 fQRS 组 17 例（10%）因心血管原因死亡，持续性 fQRS 组 22 例（20%），一过性 fQRS 组 3 例（8%）。同样，有 fQRS 的患者非致命性复发性 MI 更常见（持续性 fQRS 和一过性 fQRS 分别为 18（16%）和 10（27%）），而无 fQRS 组为 16（10%）（p=0.019）。然而，心力衰竭症状和室性心律失常的发生并无显著差异（p=0.162 和 p=0.242）。Kaplan-Meier 生存分析显示各组间存在显著差异（对数秩检验 p=0.026），仅持续性 fQRS 与生存率降低相关。多变量 Cox 回归分析显示，GRACE 评分、入院时血糖和急性期β受体阻滞剂是 2 年时 MACE 的独立预测因素。fQRS 不是 MACE 的显著独立预测因素（HR（95%CI）：1.57（0.95-2.60）；p=0.08）。此外，在单因素分析中，fQRS 不是心力衰竭或室性心律失常的预测因素。
结论
12 导联心电图上持续性 fQRS 是 AMI 后生存率降低的标志物，而一过性 fQRS 与复发性 MI 相关。
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