Bekar Lütfü, Katar Muzaffer, Yetim Mücahit, Çelik Oğuzhan, Kilci Hakan, Önalan Orhan
Department of Cardiology, Hitit University Çorum Training and Research Hospital, Çorum, Turkey.
Department of Medical Biochemistry, Tokat Government Hospital, Tokat, Turkey.
Turk Kardiyol Dern Ars. 2016 Oct;44(7):554-560. doi: 10.5543/tkda.2016.55256.
Carboxy-terminal propeptide of type 1 procollagen (PICP) is a marker of extracellular collagen synthesis. Fragmented QRS (fQRS) on a 12-lead electrocardiogram (ECG) has been demonstrated as a marker of myocardial fibrosis. The present objective was to investigate the association between serum PICP concentration and presence of fQRS on ECG in hypertensive patients.
Consecutive patients with previously or newly diagnosed hypertension were included. fQRS was defined as the presence of additional R-wave (R'), or notching of R- or S-waves, or the presence of fragmentation in 2 contiguous ECG leads. Serum PICP levels were measured by ELISA method.
The study group consisted of 90 hypertensive patients (74% females, with a mean age of 54.7±8.5 years). Of these patients, 47 (52.2%) had fQRS on ECG. Age (p=0.121) and gender distribution (p=0.625) were similar in patients with or without fQRS. Receiver operating characteristic curve analysis yielded a strong predictive ability of PICP levels for the presence of fQRS (area under the curve: 0.850; 95% CI: 0.772-0.929; p<0.0001). In multivariate logistic regression analysis, PICP levels were strongly and independently associated with the presence of fQRS (OR: 1.938; 95% CI: 1.398-2.688).
Serum PICP level is a strong and independent predictor of fQRS. Discriminative performance of serum PICP levels for the presence of fQRS is high. The present results are the first to demonstrate that fQRS may indicate myocardial fibrosis in patients with hypertension.
I型前胶原羧基末端前肽（PICP）是细胞外胶原合成的标志物。12导联心电图（ECG）上的碎裂QRS波（fQRS）已被证明是心肌纤维化的标志物。本研究旨在探讨高血压患者血清PICP浓度与ECG上fQRS波的相关性。
纳入连续的既往或新诊断为高血压的患者。fQRS波定义为在2个相邻的ECG导联中出现额外的R波（R'）、R波或S波切迹或碎裂。采用酶联免疫吸附测定法（ELISA）检测血清PICP水平。
研究组包括90例高血压患者（74%为女性，平均年龄54.7±8.5岁）。其中，47例（52.2%）患者的ECG上存在fQRS波。有或无fQRS波的患者在年龄（p=0.121）和性别分布（p=0.625）方面相似。受试者工作特征曲线分析显示，PICP水平对fQRS波的存在具有较强的预测能力（曲线下面积：0.850；95%置信区间：0.772-0.929；p<0.0001）。在多因素逻辑回归分析中，PICP水平与fQRS波的存在密切且独立相关（比值比：1.938；95%置信区间：1.398-2.688）。
血清PICP水平是fQRS波的强且独立的预测指标。血清PICP水平对fQRS波存在的判别性能较高。本研究结果首次表明，fQRS波可能提示高血压患者存在心肌纤维化。
