冠状动脉搭桥手术患者中碎裂QRS与预后标志物及长期主要不良心脏事件的关系

Relationship of fragmented QRS with prognostic markers and long-term major adverse cardiac events in patients undergoing coronary artery bypass graft surgery.

作者信息

Çiçek Yüksel, Kocaman Sinan A, Durakoğlugil Murtaza E, Çetin Mustafa, Çanga Aytun, Bozok Şahin, Doğan Stk, Erdoğan Turan

机构信息

aDepartment of Cardiology, Medical Faculty, Rize University bDepartment of Cardiology, Rize Education and Research Hospital cDepartment of Cardiovascular Surgery, Medical Faculty, Rize University, Rize, Turkey.

出版信息

J Cardiovasc Med (Hagerstown). 2015 Feb;16(2):112-7. doi: 10.2459/01.JCM.0000435615.40439.68.

DOI:10.2459/01.JCM.0000435615.40439.68

PMID:25545656

Abstract

BACKGROUND

Fragmented QRS (fQRS) complex is associated with increased sudden cardiac death, recurrent cardiovascular events, morbidity and mortality. However, the prognostic role of fQRS has not been comprehensively studied in patients undergoing coronary artery bypass graft (CABG) surgery. In this study, we planned to investigate the relationship of fQRS with prognostic markers and long-term major adverse cardiovascular events (MACEs) following isolated CABG surgery.

METHODS

Two hundred and thirteen patients who underwent CABG surgery at our institution were enrolled consecutively. MACE was defined as cardiac death, recurrent myocardial infarction, decompensated heart failure and re-hospitalization. The patients were followed up for a mean duration of 26 ± 10 months for MACE.

RESULTS

Patients with fQRS had a higher rate of Q wave on ECG (30 vs. 10%, P < 0.001), more prolonged QRS time (99 ± 11 vs. 88 ± 13 ms, P < 0.001), higher EUROSCORE (4.0 ± 1.9 vs. 2.7 ± 1.5, P < 0.001) and lower left ventricular ejection fraction (44 ± 12 vs. 56 ± 12, P < 0.001) in comparison with patients with non-fQRS. In addition, patients with fQRS had increased short-term and long-term MACE (17 vs. 4%, P = 0.002; 23 vs. 6%, P < 0.001, respectively) after discharge. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of fQRS for predicting MACE were 67, 71, 23, 94 and 70%, respectively. fQRS [odds ratio (OR) 3.110, 95% confidence interval (CI) 1.157-8.362, P = 0.025] and prolonged QRS duration (>100 ms) (OR 3.898, 95% CI 1.463-10.39, P = 0.007) were the only independent predictors of long-term MACE in multivariate logistic regression analysis. However, QRS duration had a better association with MACE than the presence of fQRS.

CONCLUSION

fQRS and prolonged QRS duration may have an additional value in predicting cardiac status and long-term prognosis. Fragmentations on admission ECG and prolonged QRS duration may be useful for identifying patients with higher long-term risk who will need more intense treatment and close follow-up after CABG surgery.

摘要

背景

碎裂QRS波（fQRS）复合波与心脏性猝死、复发性心血管事件、发病率和死亡率增加相关。然而，fQRS在接受冠状动脉旁路移植术（CABG）的患者中的预后作用尚未得到全面研究。在本研究中，我们计划调查fQRS与孤立性CABG术后预后标志物及长期主要不良心血管事件（MACE）之间的关系。

方法

连续纳入在我院接受CABG手术的213例患者。MACE定义为心源性死亡、复发性心肌梗死、失代偿性心力衰竭和再次住院。对患者进行平均26±10个月的MACE随访。

结果

与非fQRS患者相比，fQRS患者心电图上Q波发生率更高（30%对10%，P<0.001），QRS时间更长（99±11对88±13毫秒，P<0.001），欧洲心脏手术风险评估系统（EUROSCORE）更高（4.0±1.9对2.7±1.5，P<0.001），左心室射血分数更低（44±12对56±12，P<0.001）。此外，fQRS患者出院后短期和长期MACE发生率增加（分别为17%对4%，P=0.002；23%对6%，P<0.001）。fQRS预测MACE的敏感性、特异性、阳性预测值、阴性预测值和诊断准确性分别为67%、71%、23%、94%和70%。在多因素逻辑回归分析中，fQRS[比值比（OR）3.110，95%置信区间（CI）1.157-8.362，P=0.025]和QRS持续时间延长（>100毫秒）（OR 3.898，95%CI 1.463-10.39，P=0.007）是长期MACE的唯一独立预测因素。然而，QRS持续时间与MACE的关联比fQRS的存在更好。