Güçlü Aydın, Nar Gökay, İçli Atilla, Özhan Nail, Sezer Siren
Department of Nephrology, Ahi Evran University Medical School, Kırşehir, Turkey.
Med Princ Pract. 2017;26(1):66-70. doi: 10.1159/000452418. Epub 2016 Oct 11.
This study aimed to evaluate the correlation between fragmented QRS complex (fQRS), aortic stiffness, and diastolic dysfunction in hemodialysis patients.
A sample of 56 patients who received hemodialysis treatment was stratified into 2 groups according to their electrocardiography (ECG) patterns with or without fQRS. Baseline characteristics and laboratory parameters of patients were documented. Conventional echocardiographic and Doppler echocardiographic procedures were performed in all patients. The mean early (Em) diastolic and late (Am) diastolic myocardial velocities were calculated. These tests were performed before dialysis. The Student t test, Mann-Whitney U test, χ2 test, Spearman correlation, and multivariate linear regression analysis were used to analyze parameters where appropriate.
Of the 56 patients under hemodialysis, fQRS in ECG was detected in 26 (46.4%). Echocardiographic evaluation showed that deceleration time (237.57 ± 40.10 ms; p = 0.030), isovolumic relaxation time (126.84 ± 15.62 ms; p < 0.001), early (E)/late (A) ventricular filling velocity (E/A) ratio (1.15 ± 0.40; p ≤ 0.001), and aortic stiffness index value (9.62 ± 4.53; p = 0.016) exhibited a statistical increase in hemodialysis patients with fQRS compared to patients without fQRS. E (58.23 ± 19.96 m/s; p = 0.004), and Em (5.96 ± 2.08 cm/s; p = 0.023) velocity levels were significantly lower in hemodialysis patients with fQRS than patients without fQRS. Aortic stiffness closely correlated with diastolic dysfunction (deceleration time r = 0.273, p = 0.042; isovolumic relaxation time r = 0.497, p < 0.001; E/A ratio r = -0.449, p = 0.001). On multivariate linear regression analysis, fQRS and aortic stiffness were independently associated in hemodialysis patients (β = 0.321, p = 0.049).
Increased aortic stiffness and left ventricular systolic dysfunction were observed more frequently in hemodialysis patients with fQRS than in patients without fQRS. fQRS is an important determinant of aortic stiffness in hemodialysis patients.
本研究旨在评估血液透析患者中碎裂QRS波群（fQRS）、主动脉僵硬度和舒张功能障碍之间的相关性。
选取56例接受血液透析治疗的患者，根据其心电图（ECG）有无fQRS波群分为2组。记录患者的基线特征和实验室参数。对所有患者进行常规超声心动图和多普勒超声心动图检查。计算舒张早期（Em）和舒张晚期（Am）心肌平均速度。这些检查均在透析前进行。在适当情况下，采用Student t检验、Mann-Whitney U检验、χ2检验、Spearman相关性分析和多元线性回归分析来分析参数。
56例血液透析患者中，26例（46.4%）心电图检测到fQRS波群。超声心动图评估显示，与无fQRS波群的患者相比，有fQRS波群的血液透析患者的减速时间（237.57±40.10毫秒；p = 0.030）、等容舒张时间（126.84±15.62毫秒；p < 0.001）、心室舒张早期（E）/晚期（A）充盈速度（E/A）比值（1.15±0.40；p≤0.001）和主动脉僵硬度指数值（9.62±4.53；p = 0.016）均有统计学意义的升高。有fQRS波群的血液透析患者的E（58.23±19.96厘米/秒；p = 0.004）和Em（5.96±2.08厘米/秒；p = 0.023）速度水平显著低于无fQRS波群的患者。主动脉僵硬度与舒张功能障碍密切相关（减速时间r = 0.273，p = 0.042；等容舒张时间r = 0.497，p < 0.001；E/A比值r = -0.449，p = 0.001）。多元线性回归分析显示，在血液透析患者中，fQRS波群和主动脉僵硬度独立相关（β = 0.321，p = 0.049）。
与无fQRS波群的患者相比，有fQRS波群的血液透析患者更常出现主动脉僵硬度增加和左心室收缩功能障碍。fQRS波群是血液透析患者主动脉僵硬度的重要决定因素。
