起搏心电图上出现切迹QRS波作为心脏再同步治疗反应不佳的预测指标。
Presence of notched QRS on paced electrocardiographs as a predictor of poor response to cardiac resynchronization therapy.
作者信息
Wang Jiayu, Zhang Ping, Li Xuebin, Zhu Tiangang, Li Hua, Wang Long, Li Ding, Wu Cuncao, Gao Ying, Tian Yun, Guo Jihong
机构信息
Department of Cardiac Electrophysiology, People's Hospital, Peking University, Beijing 100044, China.
Department of Cardiac Electrophysiology, People's Hospital, Peking University, Beijing 100044, China. Email:
出版信息
Chin Med J (Engl). 2014;127(15):2727-34.
BACKGROUND
Cardiac resynchronization therapy (CRT) on patients with advanced and refractory heart failure has made remarkable progress. Clinically, notched QRS (nQRS) is commonly seen on electrocardiographs (ECGs) with bundle branch block morphology and on paced ECGs after implantation of a CRT device, which may reflect the heterogeneity of ventricular myocardial depolarization and electrical activity. The aim of this study was to determine whether patients with more nQRS myocardial segments on paced ECGs had a worse response to CRT than patients with fewer nQRS myocardial segments.
METHODS
We prospectively enrolled 56 patients of CRT with chronic heart failure from People's Hospital affiliated to Peking University from January 2007 to October 2013. Based on nQRS segments on ECGs before CRT, we allocated them to two groups: fewer nQRS (<2) myocardial segments (lateral, inferior, anterior segments) group (F-nQRS, G1, n = 23) and more nQRS (≥2) myocardial segments group (M-nQRS, G2, n = 33). Then according to nQRS segments on ECGs after CRT, we divided them into two groups similarly: fewer nQRS (<2) myocardial segments group (G3, n = 24) and more nQRS (≥2) myocardial segments group (G4, n = 32). This study was approved by the ethics committee of People's Hospital.
RESULTS
At 6 months in the baseline-ECG group, there was a greater absolute increase in left ventricular ejection fraction (LVEF) in G2 than in G1 ((11.5±8.9)% vs. (5.5±10.4)%, P = 0.023), with the incidence of nonresponse lower in G2 than in G1 (9.1% vs. 39.1%, P = 0.018). In the paced-ECG group, the absolute increase in LVEF was less in G4 than in G3 ((6.4±8.8)% vs. (12.5±10.4)%, P = 0.024) and the incidence of nonresponse was higher in G4 than in G3 (31.3% vs. 8.3%, P = 0.039). Multivariate analysis showed that fewer nQRS (<2) myocardial segments on paced ECGs (odds ratio 13.920) was a predictor of positive response to CRT.
CONCLUSION
nQRS ≥2 myocardial segments (lateral, inferior, anterior) on paced ECGs may predict a poor response to CRT.
背景
心脏再同步治疗（CRT）在晚期难治性心力衰竭患者中取得了显著进展。临床上，在具有束支传导阻滞形态的心电图（ECG）以及CRT装置植入后的起搏心电图上常见切迹QRS波（nQRS），这可能反映了心室肌去极化和电活动的异质性。本研究的目的是确定起搏心电图上nQRS心肌节段较多的患者与nQRS心肌节段较少的患者相比，对CRT的反应是否更差。
方法
我们前瞻性纳入了2007年1月至2013年10月北京大学人民医院的56例慢性心力衰竭CRT患者。根据CRT前心电图上的nQRS节段，将他们分为两组：nQRS心肌节段较少（<2个，即侧壁、下壁、前壁节段）组（F-nQRS，G1，n = 23）和nQRS心肌节段较多（≥2个）组（M-nQRS，G2，n = 33）。然后根据CRT后心电图上的nQRS节段，同样将他们分为两组：nQRS心肌节段较少（<2个）组（G3，n = 24）和nQRS心肌节段较多（≥2个）组（G4，n = 32）。本研究经人民医院伦理委员会批准。
结果
在基线心电图组6个月时，G2组左心室射血分数（LVEF）的绝对增加值大于G1组（（11.5±8.9）%对（5.5±10.4）%，P = 0.023），G2组无反应发生率低于G1组（9.1%对39.1%，P = 0.018）。在起搏心电图组中，G4组LVEF的绝对增加值小于G3组（（6.4±8.8）%对（12.5±10.4）%，P = 0.024），G4组无反应发生率高于G3组（31.3%对8.3%，P = 0.039）。多因素分析显示，起搏心电图上nQRS（<2）心肌节段较少（优势比13.920）是CRT阳性反应的预测指标。
结论
起搏心电图上nQRS≥2个心肌节段（侧壁、下壁、前壁）可能预示对CRT反应不佳。
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