Kanitsoraphan Chanavuth, Rattanawong Pattara, Mekraksakit Poemlarp, Chongsathidkiet Pakawat, Riangwiwat Tanawan, Kanjanahattakij Napatt, Vutthikraivit Wasawat, Klomjit Saranapoom, Thavaraputta Subhanudh
Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
University of Hawaii Internal Medicine Residency Program, Honolulu, Hawaii.
Ann Noninvasive Electrocardiol. 2019 Mar;24(2):e12597. doi: 10.1111/anec.12597. Epub 2018 Oct 17.
Recent studies suggested that fragmented (fQRS) is associated with poor clinical outcomes in heart failure with reduced ejection fraction (HFrEF) patients. However, no systematic review or meta-analysis has been done. We conducted a systematic review and meta-analysis to assess the association between baseline fQRS and all-cause mortality in HFrEF.
We comprehensively reviewed the databases of MEDLINE and EMBASE from inception to February 2018. Published studies of HFrEF that reported fQRS and outcome of all-cause mortality and major arrhythmic event (sudden cardiac death, sudden cardiac arrest, ventricular fibrillation, or sustained ventricular tachycardia) were included. Data were integrated using the random-effects, generic inverse-variance method of DerSimonian and Laird.
Ten studies from 2010 to 2017 were included. Baseline fQRS was associated with increased all-cause mortality (risk ratio [RR] 1.63, 95% confidence interval [CI] 1.22-2.19, p < 0.0001, I = 73%) as well as major arrhythmic events (RR = 1.74, 95% CI 1.09-2.80, I = 89%). Baseline fQRS increased all-cause mortality in both Asian and Caucasian cohorts (RR = 2.17 with 95% CI 1.33-3.55 and RR = 1.45 with 95% CI 1.05-1.99, respectively) as well as increased major arrhythmic events in Asian cohort (RR = 1.50, 95% CI 1.05-2.13). Baseline fQRS also increased all-cause mortality in patients who had not received implantable cardioverter-defibrillator, significantly more than in patients who had received implantable cardioverter-defibrillator (RR = 2.46 with 95% CI 1.56-3.89 and 1.36 with 95% CI 1.08-1.71, respectively).
Baseline fQRS is associated with increased all-cause mortality up to 1.63-fold in HFrEF patients. Fragmented QRS could be a predictor of clinical outcome in patients with HFrEF.
近期研究表明，碎裂QRS波（fQRS）与射血分数降低的心力衰竭（HFrEF）患者的不良临床结局相关。然而，尚未进行系统评价或荟萃分析。我们进行了一项系统评价和荟萃分析，以评估HFrEF患者基线fQRS与全因死亡率之间的关联。
我们全面检索了MEDLINE和EMBASE数据库，检索时间从建库至2018年2月。纳入已发表的关于HFrEF且报告了fQRS以及全因死亡率和主要心律失常事件（心源性猝死、心脏骤停、室颤或持续性室性心动过速）结局的研究。采用DerSimonian和Laird的随机效应、通用逆方差法整合数据。
纳入了2010年至2017年的10项研究。基线fQRS与全因死亡率增加相关（风险比[RR]1.63，95%置信区间[CI]1.22 - 2.19，p < 0.0001，I² = 73%）以及主要心律失常事件相关（RR = 1.74，95%CI 1.09 - 2.80，I² = 89%）。基线fQRS在亚洲和白种人队列中均增加全因死亡率（RR分别为2.17，95%CI 1.33 - 3.55和RR为1.45，95%CI 1.05 - 1.99），并且在亚洲队列中增加主要心律失常事件（RR = 1.50，95%CI 1.05 - 2.13）。基线fQRS在未接受植入式心脏复律除颤器的患者中也增加全因死亡率，显著高于接受植入式心脏复律除颤器的患者（RR分别为2.46，95%CI 1.56 - 3.89和1.36，95%CI 1.08 - 1.71）。
基线fQRS与HFrEF患者全因死亡率增加相关，高达1.63倍。碎裂QRS波可能是HFrEF患者临床结局的一个预测指标。
