Christou Georgios A, Christou Maria A, Christou Konstantinos A, Christodoulou Dimitrios K, Kiortsis Dimitrios N
Department of Radiology, Faculty of Medicine, University of Ioannina, 45332 Ioannina, Greece.
Atherothrombosis Research Centre, Faculty of Medicine, University of Ioannina, 45332 Ioannina, Greece.
J Clin Med. 2024 May 7;13(10):2741. doi: 10.3390/jcm13102741.
QRS fragmentation has not been linked with increased mortality in individuals without known cardiac disease. We aimed to investigate the physiological determinants of QRS fragmentation in individuals without cardiac disease. Study participants were 163 (54 athletes, 109 nonathletes) asymptomatic individuals with QRS fragmentation but without cardiac disease. QRS fragmentation was assessed in the supine position after deep inspiration or standing up and during exercise. The changes in QRS fragmentation were evaluated over a median follow-up period of 2.3 (0.8-4.9) years. The most common lead with QRS fragmentation was III (63.0% in athletes, 61.5% in nonathletes), immediately followed by V1 (50.0%) and aVF (42.6%) in athletes and aVF (55.0%) in nonathletes. QRS fragmentation in V1 was more frequent in athletes compared to nonathletes ( < 0.001). Among athletes, the presence of QRS fragmentation in V1 could be independently predicted by increased RVOTproxi (right ventricular outflow tract proximal diameter indexed to body surface area) ( < 0.001). Among individuals with QRS fragmentation in V1, deep inspiration resulted in disappearance of QRS fragmentation more frequently in nonathletes compared to athletes (100% vs. 20%, = 0.003). Deep inspiration resulted in disappearance of QRS fragmentation in aVF ( < 0.001). The presence of QRS fragmentation in II or aVF was associated with increased body mass index (BMI) ( = 0.003). Among athletes without QRS fragmentation in V1 at baseline, the appearance of QRS fragmentation in V1 at the end of follow-up was associated with greater training age ( = 0.034). Among individuals with QRS fragmentation in aVF at baseline, the disappearance of QRS fragmentation in aVF at the end of follow-up was associated with greater reduction in BMI ( = 0.008). The characteristic feature of QRS fragmentation in athletes was the presence of QRS fragmentation in V1, which was associated with RVOTproxi. The persistence of QRS fragmentation in V1 after deep inspiration could serve as a specific marker of exercise-training-related cardiac adaptation. The presence of QRS fragmentation in the leads of the frontal plane was influenced by BMI and respiration phase.
QRS波碎裂与无已知心脏病个体的死亡率增加无关。我们旨在研究无心脏病个体QRS波碎裂的生理决定因素。研究参与者为163名（54名运动员，109名非运动员）有QRS波碎裂但无心脏病的无症状个体。在深吸气后仰卧位、站立位及运动期间评估QRS波碎裂情况。在中位随访期2.3（0.8 - 4.9）年期间评估QRS波碎裂的变化。出现QRS波碎裂最常见的导联是Ⅲ导联（运动员中为63.0%，非运动员中为61.5%），紧随其后的是V1导联（运动员中为50.0%）和aVF导联（运动员中为42.6%，非运动员中为55.0%）。与非运动员相比，V1导联的QRS波碎裂在运动员中更常见（<0.001）。在运动员中，V1导联出现QRS波碎裂可通过右心室流出道近端直径指数（RVOTproxi，右心室流出道近端直径与体表面积的比值）增加独立预测（<0.001）。在V1导联有QRS波碎裂的个体中，与运动员相比，深吸气导致QRS波碎裂消失在非运动员中更常见（100%对20%，P = 0.003）。深吸气导致aVF导联的QRS波碎裂消失（<0.001）。Ⅱ导联或aVF导联出现QRS波碎裂与体重指数（BMI）增加相关（P = 0.003）。在基线时V1导联无QRS波碎裂的运动员中，随访结束时V1导联出现QRS波碎裂与训练年限更长相关（P = 0.034）。在基线时aVF导联有QRS波碎裂的个体中，随访结束时aVF导联QRS波碎裂消失与BMI降低幅度更大相关（P = 0.008）。运动员QRS波碎裂的特征是V1导联出现QRS波碎裂，这与RVOTproxi相关。深吸气后V1导联QRS波碎裂持续存在可作为运动训练相关心脏适应性的一个特异性标志物。额面导联出现QRS波碎裂受BMI和呼吸相位影响。
