Zangiabadian Moein, Sharifian Ardestani Mohammad, Rezaee Malihe, Saberi Sharbabaki Elahe, Nikoohemmat Mahdi, Eslami Mohammad, Goudarzi Kian, Sanjari Mojgan, Namazi Mohammad Hasan, Akbarzadeh Mohammad Ali, Aletaha Azadeh
Endocrinology and Metabolism Research Center Kerman University of Medical Sciences Kerman Iran.
Cardiovascular Research Center Shahid Beheshti University of Medical Sciences Tehran Iran.
Health Sci Rep. 2024 Feb 14;7(2):e1888. doi: 10.1002/hsr2.1888. eCollection 2024 Feb.
Fragmented QRS (fQRS), which is associated with rhythm disturbances, can predispose the heart to fatal ventricular arrhythmias. Recently, accumulating studies indicates that fQRS is associated with poor prognosis in various types of cardiomyopathies. Therefore, we assessed the association between fQRS with all-cause mortality and major arrhythmic events (MAEs) in patients with nonischemic cardiomyopathy, in this systematic review and meta-analysis study.
We performed a comprehensive search in databases of PubMed/Medline, EMBASE, and Web of Science from the beginning to December 31, 2022. Published observational studies (cohorts, case-control, or analytical cross-sectional studies) were included that report the prognostic value of fQRS in patients with different types of nonischemic cardiomyopathies for MAEs (sudden cardiac death, sudden cardiac arrest, sustained ventricular tachycardia [VT], ventricular fibrillation [VF], and appropriate shock) and all-cause mortality. We pooled risk ratios (RRs) through raw data and adjusted hazard ratios (aHRs) using "Comprehensive Meta-Analysis" software, Version 2.0.
Nineteen cohort and three analytical cross-sectional studies were included in this meta-analysis involving a total of 4318 subjects with nonischemic cardiomyopathy (1279 with fQRS and 3039 without fQRS). FQRS was significantly associated with an increased risk of all-cause mortality in patients with nonischemic cardiomyopathy (pooled RR: 1.920; 95% confidence interval [CI]: 1.388-2.656, < 0.0001/pooled HR: 1.729; 95% CI: 1.327-2.251, < 0.0001). Also, the risk of developing MAEs in the presence of fQRS was significantly increased (pooled RR: 2.041; 95% CI: 1.644-2.533, < 0.0001/pooled HR: 3.626; 95% CI: 2.119-6.204, < 0.0001). In the subgroup analysis, the strongest association between fQRS presence and increased MAEs was observed in patients with hypertrophic cardiomyopathy (HCM) (pooled RR: 3.44; 95% CI: 2.07-5.71, < 0.0001/pooled HR: 3.21; 95% CI: 2.04-5.06, < 0.0001).
Fragmented QRS could be a prognostic marker for all-cause mortality and MAEs in patients with various types of nonischemic cardiomyopathies, particularly HCM.
碎裂QRS波（fQRS）与节律紊乱相关，可使心脏易发生致命性室性心律失常。最近，越来越多的研究表明，fQRS与各种类型心肌病的不良预后相关。因此，在这项系统评价和荟萃分析研究中，我们评估了非缺血性心肌病患者中fQRS与全因死亡率和主要心律失常事件（MAEs）之间的关联。
我们在PubMed/Medline、EMBASE和Web of Science数据库中进行了全面检索，检索时间从开始至2022年12月31日。纳入已发表的观察性研究（队列研究、病例对照研究或分析性横断面研究），这些研究报告了fQRS在不同类型非缺血性心肌病患者中对MAEs（心源性猝死、心脏骤停、持续性室性心动过速[VT]、心室颤动[VF]和适当电击）和全因死亡率的预后价值。我们使用“综合荟萃分析”软件2.0版通过原始数据汇总风险比（RRs）并调整风险比（aHRs）。
本荟萃分析纳入了19项队列研究和3项分析性横断面研究，共涉及4318例非缺血性心肌病患者（1279例有fQRS，3039例无fQRS）。fQRS与非缺血性心肌病患者全因死亡风险增加显著相关（汇总RR：1.920；95%置信区间[CI]：1.388 - 2.656，<0.0001/汇总HR：1.729；95% CI：1.327 - 2.251，<0.0001）。此外，存在fQRS时发生MAEs的风险显著增加（汇总RR：2.041；95% CI：1.644 - 2.533，<0.0001/汇总HR：3.626；95% CI：2.119 - 6.204，<0.0001）。在亚组分析中，肥厚型心肌病（HCM）患者中观察到fQRS存在与MAEs增加之间的关联最强（汇总RR：3.44；95% CI：2.07 - 5.71，<0.0001/汇总HR：3.21；95% CI：2.04 - 5.06，<0.0001）。
碎裂QRS波可能是各种类型非缺血性心肌病患者，尤其是HCM患者全因死亡率和MAEs的预后标志物。
