Gulsen Kamil, Ince Orhan, Kum Gokmen, Ozkalayci Flora, Sahin Irfan, Okuyan Ertugrul
Health and Science University, Bagcilar Training and Research Hospital, Istanbul, Turkey.
Hisar Intercontinental Hospital, Istanbul, Turkey.
Ann Noninvasive Electrocardiol. 2019 Mar;24(2):e12618. doi: 10.1111/anec.12618. Epub 2018 Nov 7.
Fragmented QRS evaluated in 12-derivation electrocardiography has widely been accepted as a sign of myocardial fibrosis. The prognostic value of that marker has been demonstrated, particularly, in cardiac diseases that accompany myocardial scar and fibrosis. Myocardial fibrosis is also an issue in patients with aortic stenosis. In this study, we wanted to determine whether fragmented QRS could predict all-cause mortality in aortic stenosis patients after transcatheter aortic valve replacement (TAVR).
In this study, we evaluated a total of 116 eligible patients on whom we performed TAVR between 2014 and 2018. Patients' demographic and clinical findings, echocardiography results, in-hospital and 30-day mortality, long-term survival statuses were noted. Patient's ECGs before the procedure were evaluated in regard to the occurrence of fragmented QRS. Predictors of mortality were evaluated using univariable and multivariable Cox regression analysis.
The study population consisted of 116 patients of median age 79 (IQR 75-83), 64 females (55.2%). Mortality occurred in 27 (23%) patients; median follow-up time was 319 (IQR 122-719) days. Fragmented QRS was observed in 44 out of 116 (37.9%) patients. The presence of a fragmented QRS (HR = 2.178, 95% CI 0.999-4.847, p = 0.050), a history of stroke (HR = 3.463, 95% CI 1.276-9.398, p = 0.015), and the creatinine levels at admission (HR = 2.198, 95% CI 1.068-4.520, p = 0.030) were associated with the long-term mortality in multivariable Cox regression analysis.
Like in the case of the other diseases associated with myocardial fibrosis, fragmented QRS could also predict mortality in aortic stenosis patients after TAVR procedure.
12导联心电图评估的碎裂QRS波已被广泛认为是心肌纤维化的标志。该标志物的预后价值已得到证实，特别是在伴有心肌瘢痕和纤维化的心脏疾病中。心肌纤维化在主动脉瓣狭窄患者中也是一个问题。在本研究中，我们想确定碎裂QRS波是否能预测经导管主动脉瓣置换术（TAVR）后主动脉瓣狭窄患者的全因死亡率。
在本研究中，我们评估了2014年至2018年间共116例接受TAVR的符合条件的患者。记录患者的人口统计学和临床特征、超声心动图结果、住院期间和30天死亡率、长期生存状况。术前评估患者心电图中碎裂QRS波的发生情况。使用单变量和多变量Cox回归分析评估死亡率的预测因素。
研究人群包括116例患者，中位年龄79岁（四分位间距75 - 83岁），64例女性（55.2%）。27例（23%）患者死亡；中位随访时间为319天（四分位间距122 - 719天）。116例患者中有44例（37.9%）观察到碎裂QRS波。在多变量Cox回归分析中，碎裂QRS波的存在（HR = 2.178，95%可信区间0.999 - 4.847，p = 0.050）、中风病史（HR = 3.463，95%可信区间1.276 - 9.398，p = 0.015）和入院时的肌酐水平（HR = 2.198，95%可信区间1.068 - 4.520，p = 0.030）与长期死亡率相关。
与其他与心肌纤维化相关的疾病一样，碎裂QRS波也可以预测TAVR术后主动脉瓣狭窄患者的死亡率。
