Zhao Ling, Lu Juan, Cui Zhi-Min, Pavri Behzad B, Dai Min, Qian Da-Jun, Shen Wei-Gang, Guo Tao, Wang Ru-Xing
Department of Cardiology, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, PR China.
Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu 214023, PR China.
Europace. 2015 Nov;17(11):1712-9. doi: 10.1093/europace/euu408. Epub 2015 Mar 29.
Fragmented QRS (f-QRS) complexes are associated with adverse cardiovascular events in patients with coronary heart disease; however, the effects on patients with dilated cardiomyopathy (DCM) remain elusive. This study is to investigate the changes of left ventricular (LV) synchrony and systolic function in DCM patients with f-QRS complexes.
Twenty DCM patients with f-QRS complexes and 29 DCM patients without f-QRS (n-QRS) complexes were enrolled. The LV segmental longitudinal, radial and circumferential time to peak strain and general longitudinal systolic strain, radial strain, circumferential strain were measured, respectively, by speckle tracking imaging. The LV segmental standard deviations and maximal differences were also calculated. The LV dyssynchrony was defined as the time in peak anteroseptal wall to posterior wall strain >130 ms or longitudinal strain delay index >25%. The mean QRS durations in f-QRS and n-QRS groups were not different (P = ns). The incidence of LV dyssynchrony was 15/20 (75%) vs. 5/29 (17%) in two groups (P < 0.01). Two patients died of sudden death in f-QRS group during 2 years follow-up; however, no death in n-QRS group (P < 0.05). Patients in f-QRS group showed worsening LV dyssynchrony in f-QRS group after 2 years follow-up (P < 0.05). Overall, LV function was comparable at baseline (P = ns), but had significantly worsened only in the f-QRS group (P < 0.05).
The f-QRS complex is significantly associated with LV dyssynchrony in DCM patients and can be used as a reliable index to evaluate ventricular synchrony and predict the prognosis in DCM patients with narrow QRS complexes.
碎裂QRS波（f-QRS）复合波与冠心病患者的不良心血管事件相关；然而，其对扩张型心肌病（DCM）患者的影响仍不明确。本研究旨在探讨存在f-QRS复合波的DCM患者左心室（LV）同步性和收缩功能的变化。
纳入20例存在f-QRS复合波的DCM患者和29例不存在f-QRS复合波（n-QRS）的DCM患者。分别采用斑点追踪成像测量LV节段的纵向、径向和圆周方向达到峰值应变的时间以及整体纵向收缩期应变、径向应变、圆周应变。还计算了LV节段的标准差和最大差值。LV不同步定义为前间隔壁至后壁应变达到峰值的时间>130 ms或纵向应变延迟指数>25%。f-QRS组和n-QRS组的平均QRS时限无差异（P=无统计学意义）。两组LV不同步的发生率分别为15/20（75%）和5/29（17%）（P<0.01）。f-QRS组有2例患者在2年随访期间死于猝死；然而，n-QRS组无死亡病例（P<0.05）。随访2年后，f-QRS组患者的LV不同步情况恶化（P<0.05）。总体而言，两组基线时LV功能相当（P=无统计学意义），但仅f-QRS组显著恶化（P<0.05）。
f-QRS复合波与DCM患者的LV不同步显著相关，可作为评估QRS波时限窄的DCM患者心室同步性和预测预后的可靠指标。
