Mahidol University Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand.
Ann Noninvasive Electrocardiol. 2020 Sep;25(5):e12761. doi: 10.1111/anec.12761. Epub 2020 Apr 22.
In patients with ischemic heart disease (IHD), many studies demonstrated an association between fragmented QRS complex (fQRS) on 12-lead ECG and myocardial scar, heart failure, and increased mortality. However, data in adults without history of IHD is limited. We aimed to evaluate whether there is an association between fQRS and IHD diagnosed by stress cardiac MRI.
We retrospectively reviewed demographic data, 12-lead ECG, and stress cardiac MRI data from 604 patients. Fragmented QRS was defined as the presence of additional R wave (R'), notching in the nadir of R or S wave, or the presence of more than one R' in any ECG leads. Both cardiac MRI and ECG were analyzed by two independent observers.
Final analysis included 554 patients, 39% were male, with a mean age of 67.8 ± 11.1 years. There was positive stress cardiac MRI in 219 patients (39.5%). Older age, diabetes mellitus, and hypertension were more frequent in the positive group (p < .05). fQRS was identified in 300 patients (54.2%). Baseline characteristic did not differ significantly between patients with and without fQRS. There is an association between fQRS and IHD, OR 1.605 (95% CI 1.14-2.27), p = .007. After adjustment for age, diabetes, hypertension, renal function, and left ventricular ejection fraction, the strong association between fQRS and IHD persisted, OR 1.71 (95% CI 1.18-2.47), p = .004.
In patients without known history of coronary artery disease, fragmented QRS is independently associated with ischemic heart disease diagnosed by stress cardiac MRI.
在缺血性心脏病（IHD）患者中，许多研究表明 12 导联心电图上的碎裂 QRS 波群（fQRS）与心肌瘢痕、心力衰竭和死亡率增加之间存在关联。然而，在没有 IHD 病史的成年人中，相关数据有限。我们旨在评估 fQRS 与通过应激心脏 MRI 诊断的 IHD 是否存在关联。
我们回顾性分析了 604 例患者的人口统计学数据、12 导联心电图和应激心脏 MRI 数据。碎裂 QRS 定义为存在额外的 R 波（R'）、在 R 或 S 波的最低点出现切迹、或在任何心电图导联中存在多个 R'。心脏 MRI 和心电图均由两位独立观察者进行分析。
最终分析纳入 554 例患者，其中 39%为男性，平均年龄为 67.8±11.1 岁。219 例（39.5%）患者存在阳性应激心脏 MRI。阳性组中年龄较大、糖尿病和高血压更为常见（p<0.05）。300 例（54.2%）患者存在 fQRS。存在和不存在 fQRS 的患者的基线特征无显著差异。fQRS 与 IHD 之间存在关联，OR 1.605（95%CI 1.14-2.27），p=0.007。调整年龄、糖尿病、高血压、肾功能和左心室射血分数后，fQRS 与 IHD 之间的强关联仍然存在，OR 1.71（95%CI 1.18-2.47），p=0.004。
在无已知冠状动脉疾病病史的患者中，碎裂 QRS 与通过应激心脏 MRI 诊断的缺血性心脏病独立相关。
