Kang Ki-Woon, Janardhan Ajit H, Jung Kyung Tae, Lee Hye Sun, Lee Moon-Hyoung, Hwang Hye Jin
Division of Cardiology, Eulji University Hospital, Daejeon, Eulji University College of Medicine, South Korea.
CardioNXT, Inc., Westminster, Colorado.
Heart Rhythm. 2014 Aug;11(8):1433-40. doi: 10.1016/j.hrthm.2014.05.002. Epub 2014 May 6.
The relationship between a fragmented QRS complex (fQRS) on 12-lead ECG and fatal arrhythmic events in hypertrophic cardiomyopathy (HCM) remains unclear.
The purpose of this study was to investigate whether fQRS is associated with ventricular arrhythmic events (VAEs) in HCM patients.
Of an initial cohort of 273 patients (57% male, mean age 55 years) diagnosed with HCM, 167 patients were included and divided into 2 groups: those with fQRS (n = 67) and those without fQRS (n = 100). fQRS was defined as notching of the R or S wave in 2 contiguous leads. VAEs were defined as nonsustained or sustained ventricular tachycardia (VT) or sudden cardiac death (SCD). Major arrhythmic events (MAEs) were sustained VT or SCD.
During mean follow-up of 6.3 years, univariate analysis showed that fQRS was significantly associated with increased VAEs (unadjusted hazard ratio [HR] 6.17, 95% confidence interval [CI] 2.46-15.49, P < .001) and MAEs (unadjusted HR 5.12, 95% CI 1.38-19.01, P = .014). Multivariate analysis revealed that fQRS was a strong independent predictor of VAEs (adjusted HR 6.28, 95% CI 2.49-15.84, P < .001) and MAEs (adjusted HR 6.04, 95% CI 1.49-24.39, P = .011). fQRS in the inferior leads was most closely related to MAEs compared to fQRS in other myocardial territories, and its inclusion in a risk calculator for mortality in HCM patients increased the positive predictive value from 8% to 25% in low-risk patients.
Presence of an fQRS may be a good candidate marker for prediction of VAE in patients with HCM.
12导联心电图上的碎裂QRS波群（fQRS）与肥厚型心肌病（HCM）患者致命性心律失常事件之间的关系仍不明确。
本研究旨在探讨fQRS是否与HCM患者的室性心律失常事件（VAEs）相关。
在最初诊断为HCM的273例患者（男性占57%，平均年龄55岁）队列中，纳入167例患者并分为两组：有fQRS组（n = 67）和无fQRS组（n = 100）。fQRS定义为两个连续导联中R波或S波有切迹。VAEs定义为非持续性或持续性室性心动过速（VT）或心源性猝死（SCD）。主要心律失常事件（MAEs）为持续性VT或SCD。
在平均6.3年的随访期间，单因素分析显示fQRS与VAEs增加显著相关（未调整风险比[HR] 6.17，95%置信区间[CI] 2.46 - 15.49，P <.001）以及与MAEs相关（未调整HR 5.12，95% CI 1.38 - 19.01，P =.014）。多因素分析显示fQRS是VAEs（调整后HR 6.28，95% CI 2.49 - 15.84，P <.001）和MAEs（调整后HR 6.04，95% CI 1.49 - 24.39，P =.011）的强有力独立预测因子。与其他心肌区域的fQRS相比，下壁导联的fQRS与MAEs关系最为密切，将其纳入HCM患者死亡风险计算器可使低风险患者的阳性预测值从8%提高到25%。
fQRS的存在可能是预测HCM患者VAEs的良好候选标志物。
