Özyılmaz Sinem, Akgül Özgür, Uyarel Hüseyin, Pusuroğlu Hamdi, Karayakalı Muammer, Gül Mehmet, Çetin Mustafa, Satılmışoğlu Hulusi, Yıldırım Aydın, Bakır İhsan
Department of Cardiology, Faculty of Medicine, Biruni University; İstanbul-Turkey.
Anatol J Cardiol. 2017 Jul;18(1):54-61. doi: 10.14744/AnatolJCardiol.2017.7593. Epub 2017 May 30.
It has been shown that the presence of fragmented QRS (fQRS) is associated with poor prognosis in many cardiovascular diseases and in patients with hypertrophic cardiomyopathy (HCM). However, no study has shown an association with the absolute risk score of sudden cardiac death. The aim of this study was to determine the relationship between QRS and the predicted risk score of sudden cardiac death at 5 years (HCM Risk-SCD) in HCM patients.
In total, 115 consecutive HCM patients were included in this prospective observational study. The patients were divided into two groups according to the presence [fQRS(+) group (n=65)] or absence [fQRS(-) group (n=50)] of fQRS on a 12-lead electrocardiogram (ECG).
The HCM Risk-SCD (%) HCM Risk-SCD (>6%) values and some echocardiographic parameters, including ventricular extrasystole, ventricular tachycardia, cardiopulmonary resuscitation, implantable cardioverter defibrillator implantation, appropriate shock, and heart failure at the time of admission, were significantly higher in the fQRS(+) group than in the fQRS(-) group (all p<0.05). Both univariate and multivariate analyses revealed fQRS and New York Heart Association (NYHA) class as independent predictors of HCM Risk-SCD. In a receiver operating characteristic (ROC) curve analysis, an HCM Risk-SCD value of >4 was identified as an effective cut-off point in fQRS for HCM. An HCM Risk-SCD value of >4 yielded a sensitivity of 77% and a specificity of 76%.
fQRS is determined to be an independent high-risk indicator of HCM Risk-SCD. It seems to be associated with increased ventricular arrhythmias and some echocardiographic parameters.
已有研究表明，碎裂QRS波（fQRS）的存在与多种心血管疾病及肥厚型心肌病（HCM）患者的不良预后相关。然而，尚无研究表明其与心源性猝死的绝对风险评分有关。本研究旨在确定HCM患者QRS波与5年心源性猝死预测风险评分（HCM Risk-SCD）之间的关系。
本前瞻性观察性研究共纳入115例连续的HCM患者。根据12导联心电图（ECG）上fQRS波的有无，将患者分为两组：存在fQRS波组[fQRS(+)组，n = 65]和不存在fQRS波组[fQRS(-)组，n = 50]。
fQRS(+)组的HCM Risk-SCD（%）、HCM Risk-SCD（>6%）值以及一些超声心动图参数，包括室性早搏、室性心动过速、心肺复苏、植入式心脏复律除颤器植入、恰当电击和入院时的心力衰竭，均显著高于fQRS(-)组（所有p<0.05）。单因素和多因素分析均显示fQRS波和纽约心脏协会（NYHA）心功能分级是HCM Risk-SCD的独立预测因素。在受试者工作特征（ROC）曲线分析中，HCM Risk-SCD值>4被确定为HCM患者fQRS波的有效截断点。HCM Risk-SCD值>4时，敏感性为77%，特异性为76%。
fQRS波被确定为HCM Risk-SCD的独立高危指标。它似乎与室性心律失常增加及一些超声心动图参数有关。
