Younis Ahmad Salah, El-Halag Moataz Ibrahim, ElBadry Mahmoud Ali, Abbas Nora Ismail Mohamed
Department of Critical Care Medicine, Faculty of Medicine, Cairo University, Kasr alAiny Street, Cairo, 11562, Egypt.
Egypt Heart J. 2020 Jul 23;72(1):43. doi: 10.1186/s43044-020-00076-y.
Worldwide, coronary heart disease (CHD) is topping the foremost important chief causes of mortality. Fragmented QRS (f-QRS) is a pattern of QRS complex in 12 leads surface ECG which showed a promising value in predicting the outcome in cardiac diseases including ischemic heart disease. We aimed to research the importance of using f-QRS as a non-invasive and cheap tool for the prediction of cardiogenic shock and mortality in acute coronary syndrome (ACS).
A retrospective study includes eighty four critically ill ACS patients. Patients were classified consistent with the presence or absence of fragmented QRS into two groups (46 and 38 patients respectively). Exclusion criteria include past history of important ischemic events (MI, PCI, and CABG), permanent AF, and/or cardiomyopathy. No statistical significant differences were detected between the 2 groups as regards the age, gender, major risk factors of ischemic heart condition, cardiac bio-markers, Killip class, LVEF, updated GRACE risk score of ACS, and in-hospital mortality.
A number value of f-QRS leads > 3 yields sensitivity and specificity (83.3% and 72.5% respectively) for predicting hospital mortality. The f-QRS group was further split-up according to the numbers of f-QRS leads into 2 subgroups; subgroup (A1) including patients with > 3 f-QRS leads and subgroup (A2) including patients ≤ 3 f-QRS leads. Subgroup (A2) showed considerable difference as regards some important variables including a higher SBP (P = 0.016), a slower HR (P = 0.014), a lower up-dated GRACE risk score (3.22 ± 6.95 vs 6.81 ± 12, P value 0.048), and a lower rate of hospital death (1/30 vs. 5/16, P = 0.015). Anterior f-QRS showed statistically significant higher HR, lower SBP, a higher frequency of shock, a higher updated GRACE risk score, and a higher chance of in-hospital mortality (P = 0.004) compared to non-anterior f-QRS.
The position and number of f-QRS leads provide a non-invasive and a readily accessible tool to predict the prognosis, occurrence of cardiogenic shock, and in-hospital mortality.
在全球范围内，冠心病（CHD）是首要的重要死亡原因。碎裂QRS波（f-QRS）是12导联体表心电图上QRS波群的一种形态，在预测包括缺血性心脏病在内的心脏疾病的预后方面显示出有前景的价值。我们旨在研究将f-QRS作为一种非侵入性且廉价的工具来预测急性冠状动脉综合征（ACS）的心源性休克和死亡率的重要性。
一项回顾性研究纳入了84例重症ACS患者。根据是否存在碎裂QRS波将患者分为两组（分别为46例和38例）。排除标准包括既往有重大缺血事件（心肌梗死、经皮冠状动脉介入治疗、冠状动脉旁路移植术）史、永久性房颤和/或心肌病。两组在年龄、性别、缺血性心脏病的主要危险因素、心脏生物标志物、Killip分级、左心室射血分数、ACS的更新GRACE风险评分以及住院死亡率方面未检测到统计学显著差异。
f-QRS导联数>3时预测住院死亡率的灵敏度和特异度分别为83.3%和72.5%。f-QRS组根据f-QRS导联数进一步分为2个亚组；亚组（A1）包括f-QRS导联数>3的患者，亚组（A2）包括f-QRS导联数≤3的患者。亚组（A2）在一些重要变量方面显示出显著差异，包括较高的收缩压（P = 0.016）、较慢的心率（P = 0.014）、较低的更新GRACE风险评分（3.22±6.95 vs. 6.81±12，P值0.048）以及较低的医院死亡率（1/30 vs. 5/16，P = 0.015）。与非前壁f-QRS相比，前壁f-QRS在统计学上显示出更高的心率、更低的收缩压、更高的休克发生率、更高的更新GRACE风险评分以及更高的住院死亡率（P = 0.004）。
f-QRS导联的位置和数量提供了一种非侵入性且易于获取的工具来预测预后、心源性休克的发生以及住院死亡率。
