Hiraiwa Hiroaki, Okumura Takahiro, Sawamura Akinori, Sugiura Yuki, Kondo Toru, Watanabe Naoki, Aoki Soichiro, Ichii Takeo, Kitagawa Katsuhide, Kano Naoaki, Fukaya Kenji, Furusawa Kenji, Morimoto Ryota, Takeshita Kyosuke, Bando Yasuko K, Murohara Toyoaki
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
J Cardiol. 2018 Mar;71(3):284-290. doi: 10.1016/j.jjcc.2017.09.002. Epub 2017 Oct 21.
Myocardial fibrosis is associated with poor prognosis in nonischemic dilated cardiomyopathy (NIDCM) patients. The Selvester QRS score on 12-lead electrocardiogram is associated with both the amount of myocardial scar and poor prognosis in myocardial infarction patients. However, its use in NIDCM patients is limited. We investigated the prognostic value of the QRS score and its association with collagen volume fraction (CVF) in NIDCM patients.
We enrolled 91 consecutive NIDCM patients (66 men, 53±13 years) without permanent pacemakers or cardiac resynchronization therapy devices. The Selvester QRS score was calculated by two expert cardiologists at NIDCM diagnosis. All patients were followed up over 4.5±3.2 years. Cardiac events were defined as a composite of cardiac death, hospitalization for worsening heart failure, and lethal arrhythmia. We also evaluated CVF using endomyocardial biopsy samples.
At baseline, the left ventricular ejection fraction was 32±9%, plasma brain natriuretic peptide level was 80 [43-237] pg/mL, and mean Selvester QRS score was 4.1 points. Twenty cardiac events were observed (cardiac death, n=1; hospitalization for worsening heart failure, n=16; lethal arrhythmia, n=3). Cox proportional hazard regression analysis revealed that the Selvester QRS score was an independent determinant of cardiac events (hazard ratio, 1.32; 95% confidence interval, 1.05-1.67; p=0.02). The best cut-off value was determined as 3 points, with 85% sensitivity and 47% specificity (area under the curve, 0.688, p=0.011). In Kaplan-Meier survival analysis, the QRS score ≥3 group had more cardiac events than the QRS score <3 group (log-rank, p=0.007). Further, there was a significant positive correlation of Selvester QRS score with CVF (r=0.46, p<0.001).
The Selvester QRS score can predict future cardiac events in NIDCM, reflecting myocardial fibrosis assessed by CVF.
心肌纤维化与非缺血性扩张型心肌病（NIDCM）患者的不良预后相关。12导联心电图上的塞尔维斯特QRS评分与心肌梗死患者的心肌瘢痕量及不良预后均相关。然而，其在NIDCM患者中的应用有限。我们研究了QRS评分在NIDCM患者中的预后价值及其与胶原容积分数（CVF）的关系。
我们连续纳入了91例无永久性起搏器或心脏再同步治疗装置的NIDCM患者（66例男性，年龄53±13岁）。在NIDCM诊断时由两位心脏病专家计算塞尔维斯特QRS评分。所有患者随访4.5±3.2年。心脏事件定义为心脏死亡、因心力衰竭恶化住院和致命性心律失常的复合事件。我们还使用心内膜活检样本评估CVF。
基线时，左心室射血分数为32±9%，血浆脑钠肽水平为80[43 - 237]pg/mL，平均塞尔维斯特QRS评分为4.1分。观察到20例心脏事件（心脏死亡1例，因心力衰竭恶化住院16例，致命性心律失常3例）。Cox比例风险回归分析显示，塞尔维斯特QRS评分是心脏事件的独立决定因素（风险比，1.32；95%置信区间，1.05 - 1.67；p = 0.02）。最佳截断值确定为3分，敏感性为85%，特异性为47%（曲线下面积，0.688，p = 0.011）。在Kaplan - Meier生存分析中，QRS评分≥3分组的心脏事件比QRS评分<3分组更多（对数秩检验，p = 0.007）。此外，塞尔维斯特QRS评分与CVF存在显著正相关（r = 0.46，p < 0.001）。
塞尔维斯特QRS评分可预测NIDCM患者未来的心脏事件，反映通过CVF评估的心肌纤维化。
