Bonakdar Hamidreza, Moladoust Hassan, Kheirkhah Jalal, Abbaspour Esmat, Assadian Rad Mohammad, Salari Arsalan, Barzigar Anoosh, Shad Bijan
Department of Cardiology, Heshmat Cardiovascular Research Center, Guilan University of Medical Sciences; Rasht-Iran.
Anatol J Cardiol. 2016 Feb;16(2):106-12. doi: 10.5152/akd.2015.5887. Epub 2015 Apr 9.
Fragmented QRS (fQRS) complexes that have numerous RSR´ patterns represent alteration of ventricular depolarization. We evaluated the relationship between fQRS and poor coronary collateral circulation and the diagnostic ability of fQRS for myocardial scar detection in patients with chronic total occlusion (CTO) without a history of myocardial infarction.
The study population consisted of patients undergoing coronary angiography with a suspicion of CAD. Seventy-nine patients with one totally occluded major coronary artery were enrolled. Exclusion criteria were history of MI; recent acute coronary syndrome; pathologic Q wave on 12-lead ECG; cardiomyopathy or severe valvular disease; coronary artery bypass surgery or percutaneous coronary angioplasty. Collateral circulation was scored on the basis of Rentrop's classification. All patients were assessed by myocardial perfusion SPECT. Fragmented QRS was characterized as existence of an R´ or R wave or S wave notch in two adjacent leads related to the location of a major coronary artery region. Single and multiple logistic regression analyses were completed in the forward method.
Forty-nine patients had poor and 30 had well-developed collateral circulation. Fragmented QRS complexes were significantly higher in the poor collateral group (81% vs. 20%, p<0.001). Sensitivity, specificity, and the positive and negative predictive values of fQRS for myocardial scar identification were 89.4%, 87.5%, and 91.3% and 84.8%, respectively. The summed stress score and the summed rest score on SPECT were significantly higher in the poor collateral group than in the well-developed group (p<0.001) as well as in the fQRS group than the non-fQRS group (p<0.001). Logistic regression analysis revealed that the presence of fQRS was significantly and independently associated with poor collateral circulation and myocardial scar in patients with CTO.
Fragmented QRS is independently related to poor coronary collateral circulation in patients with CTO without prior myocardial infarction. Notably, it can be a good predictor of myocardial scar rather than merely ischemia, with high diagnostic accuracy.
具有众多RSR´模式的碎裂QRS（fQRS）复合波代表心室去极化的改变。我们评估了fQRS与冠状动脉侧支循环不良之间的关系，以及fQRS对无心肌梗死病史的慢性完全闭塞（CTO）患者心肌瘢痕检测的诊断能力。
研究人群包括怀疑患有冠心病而接受冠状动脉造影的患者。纳入79例有一支主要冠状动脉完全闭塞的患者。排除标准为心肌梗死病史；近期急性冠状动脉综合征；12导联心电图上有病理性Q波；心肌病或严重瓣膜疾病；冠状动脉搭桥手术或经皮冠状动脉腔内血管成形术。根据Rentrop分类对侧支循环进行评分。所有患者均接受心肌灌注单光子发射计算机断层扫描（SPECT）评估。fQRS的特征为与主要冠状动脉区域位置相关的两个相邻导联中存在R´波或R波或S波切迹。采用向前法完成单因素和多因素逻辑回归分析。
49例患者侧支循环不良，30例患者侧支循环良好。侧支循环不良组的碎裂QRS复合波明显更高（81%对20%，p<0.001）。fQRS对心肌瘢痕识别的敏感性、特异性、阳性预测值和阴性预测值分别为89.4%、87.5%、91.3%和84.8%。侧支循环不良组SPECT上的总负荷评分和总静息评分显著高于侧支循环良好组（p<0.001）以及fQRS组高于非fQRS组（p<0.001）。逻辑回归分析显示，fQRS的存在与CTO患者侧支循环不良和心肌瘢痕显著且独立相关。
在无既往心肌梗死的CTO患者中，碎裂QRS与冠状动脉侧支循环不良独立相关。值得注意的是，它可以作为心肌瘢痕的良好预测指标，而不仅仅是缺血，具有较高的诊断准确性。
