Heer Randeep S, Selby Faye L, Mandal Amit K J, Baktash Vadir, Szawarski Piotr, Mattoo Sirtaaj, Mohiaddin Hasan, Makuloluwa Kanchani K, Chreif Hussein, Amin Fouad R, Missouris Constantinos G
Wexham Park Hospital, Frimley Health NHS Trust, Slough, UK.
Wexham Park Hospital, Frimley Health NHS Trust, Slough, UK;University of Nicosia Medical School, Nicosia, Cyprus.
Anatol J Cardiol. 2024 Mar 26;28(6):286-93. doi: 10.14744/AnatolJCardiol.2024.3494.
QRS fragmentation (fQRS) is a depolarization disorder that can be detected on routine electrocardiography (ECG). Current evidence suggests that fQRS is a prognosticator of adverse cardiovascular events. This study aimed to assess the relationship between fQRS and all-cause mortality in critically unwell coronavirus disease 2019 (COVID-19) patients and to investigate the significance of associated abnormalities on echocardiography.
A retrospective cohort study of COVID-19 patients in a critical care setting was performed. Electrocardiography was performed on presentation to hospital, admission to the critical care unit, and at subsequent points according to clinical need. Transthoracic echocardiography was performed at clinical discretion to assess for structural and functional cardiac abnormalities. Primary outcome was in-hospital mortality and secondary outcome was the need for mechanical invasive ventilation.
Totally, 212 consecutive patients were included of which 120 (57%) exhibited fQRS and inferior leads were involved in 88% of the patients. Overall, fQRS was a significant predictor of mortality [65% vs. 44% P =.003; multivariate odds ratio = 2.96, 95% confidence interval (CI): 1.42-6.40, P =.005] and inferior fQRS itself was a significant predictor of mortality (P =.03). There was no significant association between fQRS and the need for invasive mechanical ventilation. A total of 112 patients underwent echocardiography. There was a greater incidence of right ventricular (RV) dilatation in the fQRS group (16% vs. 2% respectively, P =.02) and pulmonary hypertension (33% vs. 14% respectively, P =.03) based on echocardiographic criteria.
Our study demonstrates that fQRS is significantly associated with RV dilation, pulmonary hypertension, and mortality in critically unwell COVID-19 patients.
QRS波碎裂（fQRS）是一种可在常规心电图（ECG）上检测到的去极化紊乱。目前的证据表明，fQRS是心血管不良事件的一个预后指标。本研究旨在评估fQRS与危重症冠状病毒病2019（COVID-19）患者全因死亡率之间的关系，并研究超声心动图相关异常的意义。
对危重症监护环境中的COVID-19患者进行了一项回顾性队列研究。患者入院时、入住重症监护病房时以及随后根据临床需要进行心电图检查。根据临床判断进行经胸超声心动图检查，以评估心脏结构和功能异常。主要结局是住院死亡率，次要结局是有创机械通气需求。
共纳入212例连续患者，其中120例（57%）出现fQRS，88%的患者下壁导联受累。总体而言，fQRS是死亡率的显著预测指标[65%对44%，P = 0.003；多因素比值比 = 2.96，95%置信区间（CI）：1.42 - 6.40，P = 0.005]，下壁fQRS本身是死亡率的显著预测指标（P = 0.03）。fQRS与有创机械通气需求之间无显著关联。共有112例患者接受了超声心动图检查。根据超声心动图标准，fQRS组右心室（RV）扩张的发生率更高（分别为16%对2%，P = 0.02）和肺动脉高压的发生率更高（分别为33%对14%，P = 0.03）。
我们的研究表明，fQRS与危重症COVID-19患者的RV扩张、肺动脉高压和死亡率显著相关。
