Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.
Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.
Pediatr Cardiol. 2021 Dec;42(8):1713-1721. doi: 10.1007/s00246-021-02655-5. Epub 2021 Jun 10.
Fragmented QRS is an abnormal sign in an ECG resulting from ventricular dyssynchrony. The presence of fragmented QRS (fQRS) is related to mortality in patients with repaired tetralogy of Fallot (rTOF). This study aimed to analyze the correlations between fQRS and ventricular function parameters from cardiac magnetic resonance (CMR) images. A total of 54 patients with rTOF or repaired DORV, TOF type who had been investigated by CMR at Songklanagarind Hospital from January 2012 to August 2019 were retrospectively reviewed. Most of the patients (47 patients, 87%) were diagnosed with TOF and most of these (57.4%) were treated with a transannular patch (TAP) on the right ventricular outflow tract (RVOT). Forty-four patients (81%) had fQRS. The median time interval between EKG and CMR was 4.2 months (IQR 1.1, 6.9). Patients with fQRS had significantly higher RVEDVi (145.6 [IQR 121.1, 173.1) vs. 115.9 [IQR 96.2, 146.9] mL/m, p = 0.037), higher RVESVi (82.5 [IQR 62.9, 100.8] vs. 58.6 [IQR 46, 77.2] mL/m, p = 0.032) and higher RVEDV/LVEDV ratio [1.6 (IQR 1.4, 1.9) vs. 1.4 (IQR 1.3, 1.5), p = 0.026]. The extent of fQRS was significantly associated with an increase in RVEDVi (r = 0.39, p = 0.004) and RVESVi (r = 0.45, p < 0.001) but a decrease in RVEF (r = - 0.37, p = 0.006). Fragmented QRS had higher sensitivity and lower specificity than prolonged QRS duration (≥ 160 ms) to predict all of the parameters indicating pulmonary valve replacement (PVR). Patients with rTOF who had fQRS were significantly associated with RV dilatation. The extent of fQRS had only low to moderate correlation with right ventricular parameters (RVEDVi, RVESVi and RVEF). Fragmented QRS could be used for early detection of RV dilatation and the need for PVR in patients with rTOF.
碎裂 QRS 波是心电图上源自心室失同步的异常信号。碎裂 QRS 波（fQRS）的存在与修复性法洛四联症（rTOF）患者的死亡率相关。本研究旨在分析碎裂 QRS 波与心脏磁共振（CMR）图像上的心室功能参数之间的相关性。回顾性分析了 2012 年 1 月至 2019 年 8 月在宋卡那桂医院接受 CMR 检查的 54 例 rTOF 或修复性 DORV、TOF 型患者。大多数患者（47 例，87%）被诊断为 TOF，其中大多数（57.4%）在右心室流出道（RVOT）接受了跨环补片（TAP）治疗。44 例（81%）患者存在 fQRS 波。EKG 和 CMR 之间的中位时间间隔为 4.2 个月（IQR 1.1，6.9）。存在 fQRS 波的患者 RVEDVi（145.6 [IQR 121.1，173.1） vs. 115.9 [IQR 96.2，146.9] mL/m，p = 0.037）、RVESVi（82.5 [IQR 62.9，100.8] vs. 58.6 [IQR 46，77.2] mL/m，p = 0.032）和 RVEDV/LVEDV 比值 [1.6（IQR 1.4，1.9） vs. 1.4（IQR 1.3，1.5），p = 0.026]更高。fQRS 波的程度与 RVEDVi（r = 0.39，p = 0.004）和 RVESVi（r = 0.45，p < 0.001）的增加显著相关，但与 RVEF（r = - 0.37，p = 0.006）的减少相关。与 QRS 间期延长（≥160 ms）相比，碎裂 QRS 波对预测所有表明肺动脉瓣置换（PVR）的参数具有更高的敏感性和更低的特异性。存在 fQRS 波的 rTOF 患者与 RV 扩张显著相关。fQRS 波的程度与右心室参数（RVEDVi、RVESVi 和 RVEF）仅具有低到中度相关性。碎裂 QRS 波可用于早期检测 rTOF 患者 RV 扩张和 PVR 的需求。
