Cho Min-Jung, Lee Ji-Won, Lee JeSang, Shin Yong Bum, Lee Hyoung Doo
Department of Pediatrics, Biomedical Research Institute of Pusan National University Hospital, Pusan National University Hospital, Ami-dong, Seo-gu, Busan, Republic of Korea.
Department of Radiology, Pusan National University Hospital, Busan, Republic of Korea.
Pediatr Cardiol. 2017 Jun;38(5):1042-1048. doi: 10.1007/s00246-017-1616-7. Epub 2017 Apr 29.
The presence of fragmented QRS is a known marker of heterogeneous ventricular activation around the myocardial scar area. We validated whether fragmented QRS shows any association with ventricular dysfunction, fibrosis, or ventricular arrhythmias in patients with Duchenne muscular dystrophy (DMD). Thirty-seven patients with DMD were evaluated using electrocardiography (ECG), echocardiography, cardiac magnetic resonance, and 24-h Holter monitoring. Associations between fragmented QRS and ventricular dysfunction, fibrosis, or ventricular arrhythmia were investigated. Fragmented QRS complexes were present in 31 of 37 (83.7%) patients, and they were associated with a significantly lower left ventricular ejection fraction along with an increased left ventricular Tei index as evaluated by echocardiography, and more frequent ventricular arrhythmia as indicated using 24-hour Holter monitoring compared with patients without fragmented QRS. The number of leads with fragmented QRS correlated negatively with left ventricular ejection fraction both using echocardiography (r = -0.616) and CMR (r = -0.516). Further, the number of leads with fragmented QRS showed a significant correlation with several other echocardiographic measurements (mitral Em and Sm, and left ventricular Tei index), and 2-dimensional speckle-tracking echocardiography derived global left ventricular longitudinal strain. The frequency of ventricular arrhythmia observed using Holter monitoring showed a significant positive correlation with the frequency of fragmented QRS on ECG (r = 0.674). There was a positive trend of correlation between fragmented QRS and the amount of myocardial fibrosis as assessed by late gadolinium enhancement using CMR, but the statistical significance of the relationship was low (r = 0.433, p = 0.056). Fragmentation of QRS complexes is associated with degrees of left ventricular dysfunction, fibrosis, and ventricular arrhythmias in patients with DMD.
碎裂QRS波的存在是心肌瘢痕区域周围心室激活不均一性的已知标志物。我们验证了在杜氏肌营养不良症（DMD）患者中，碎裂QRS波是否与心室功能障碍、纤维化或室性心律失常存在任何关联。对37例DMD患者进行了心电图（ECG）、超声心动图、心脏磁共振成像和24小时动态心电图监测评估。研究了碎裂QRS波与心室功能障碍、纤维化或室性心律失常之间的关联。37例患者中有31例（83.7%）存在碎裂QRS波群，与无碎裂QRS波的患者相比，经超声心动图评估，他们的左心室射血分数显著降低，左心室Tei指数升高，并且根据24小时动态心电图监测显示室性心律失常更频繁。有碎裂QRS波的导联数量与超声心动图（r = -0.616）和心脏磁共振成像（r = -0.516）测得的左心室射血分数均呈负相关。此外，有碎裂QRS波的导联数量与其他几种超声心动图测量值（二尖瓣E峰和S峰，以及左心室Tei指数）以及二维斑点追踪超声心动图得出的左心室整体纵向应变显著相关。动态心电图监测观察到的室性心律失常频率与心电图上碎裂QRS波的频率呈显著正相关（r = 0.674）。根据心脏磁共振成像使用钆延迟增强评估，碎裂QRS波与心肌纤维化程度之间存在正相关趋势，但这种关系的统计学意义较低（r = 0.433，p = 0.056）。在DMD患者中，QRS波群碎裂与左心室功能障碍、纤维化和室性心律失常的程度相关。
