fQRS对CRT植入后室性心律失常发生的预测价值
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摘要
目的探讨碎裂QRS波(fQRS)对心脏再同步治疗除颤器(CRT-D)患者术后1年内再发室性心律失常的预测价值。方法连续入选2015年1月至2017年4月在安徽省立医院住院明确诊断为心衰并植入CRT-D患者208人,根据入院时心电图是否存在fQRS波分为两组,比较两组患者基线、心电指标以及心脏彩超指标等,观察两组患者术后1年内室性心律失常的发生情况。并对12导心电图存在完全性左束支阻滞患者进行亚组分析,探讨fQRS的出现与术后室性心律失常的关系。结果①与非fQRS组比较,fQRS组QRS宽度、SPAP更大,射血分数更低,NYHA心功能分级更高(p<0.05);②Pearson相关分析显示,心电图是否存在fQRS与术后室性心律失常、SPAP、NYHA心功能分级、射血分数、QRS宽度、左室舒张末内径有关;③多因素Logistic回归分析显示,fQRS(OR=4.304, p=0.001)、射血分数(OR=0.884, p=0.003)、QRS宽度(OR=1.111, p=0.002)与术后室性心律失常独立相关;④亚组分析显示,fQRS组相较于非fQRS组,NHYA心功能分级更高、QRS宽度更宽(p<0.05),随访1年室性心律失常发生率更高(p<0.05)。结论 fQRS可作为心衰患者CRT-D植入后室性心律失常发生的预测指标。
Objective To investigate the predictive value of fragmented QRS wave(fQRS) for recurrent ventricular arrhythmia in patients with cardiac resynchronization defibrillator(CRT-D) within 1 year after operation.Methods Continuously selected from January 2015 to April 2017, 208 patients were diagnosed with heart failure and were implanted with CRT-D at Anhui Provincial Hospital, According to the presence or absence of fQRS waves in the electrocardiogram at admission, it divided into two group. The baseline,ECG and echocardiographic parameters of the two groups were compared. The incidence of ventricular arrhythmia was observed within 1 year after operation. A subgroup analysis of patients with complete left bundle branch block with 12-lead ECG was performed to investigate the relationship between the appearance of fQRS and postoperative ventricular arrhythmia. Results ①Compared with the non-fQRS group,the QRS width,SPAP was larger, the ejection fraction was lower, and the NYHA cardiac function was higher in the fQRS group(p<0.05); ②Pearson correlation analysis showed that the presence of fQRS in ECG was associated with postoperative ventricular arrhythmia, SPAP, NYHA cardiac function grading, ejection fraction, QRS width,and left ventricular end diastolic diameter; ③ Multivariate logistic regression analysis showed fQRS(OR=4.304, p=0.001), ejection fraction(OR=0.884, p=0.003), QRS width(OR=1.111, p=0.002) is independently associated with postoperative ventricular arrhythmia; ④ Subgroup analysis showed that the fQRS group was compared to the non-fQRS group, The NHYA heart function was graded higher and the QRS width was wider(p<0.05). The incidence of ventricular arrhythmia was higher at 1 year follow-up(p<0.05). Conclusions fQRS can be used as a predictor of ventricular arrhythmia after CRT-D implantation in patients with heart failure.
Objective To investigate the predictive value of fragmented QRS wave(fQRS) for recurrent ventricular arrhythmia in patients with cardiac resynchronization defibrillator(CRT-D) within 1 year after operation.Methods Continuously selected from January 2015 to April 2017, 208 patients were diagnosed with heart failure and were implanted with CRT-D at Anhui Provincial Hospital, According to the presence or absence of fQRS waves in the electrocardiogram at admission, it divided into two group. The baseline,ECG and echocardiographic parameters of the two groups were compared. The incidence of ventricular arrhythmia was observed within 1 year after operation. A subgroup analysis of patients with complete left bundle branch block with 12-lead ECG was performed to investigate the relationship between the appearance of fQRS and postoperative ventricular arrhythmia. Results ①Compared with the non-fQRS group,the QRS width,SPAP was larger, the ejection fraction was lower, and the NYHA cardiac function was higher in the fQRS group(p<0.05); ②Pearson correlation analysis showed that the presence of fQRS in ECG was associated with postoperative ventricular arrhythmia, SPAP, NYHA cardiac function grading, ejection fraction, QRS width,and left ventricular end diastolic diameter; ③ Multivariate logistic regression analysis showed fQRS(OR=4.304, p=0.001), ejection fraction(OR=0.884, p=0.003), QRS width(OR=1.111, p=0.002) is independently associated with postoperative ventricular arrhythmia; ④ Subgroup analysis showed that the fQRS group was compared to the non-fQRS group, The NHYA heart function was graded higher and the QRS width was wider(p<0.05). The incidence of ventricular arrhythmia was higher at 1 year follow-up(p<0.05). Conclusions fQRS can be used as a predictor of ventricular arrhythmia after CRT-D implantation in patients with heart failure.
引文
1 Celand JG,Daubert JC,Erdmann E,et a1.The effect of cardiac resynchronization on morbidity and mortality in heart failure.N Engl J Med,2005,352:1539-1549.
2 Marzec LN,Peterson PN,Bao H,et al.Use of Cardiac Resynchronization Therapy Among Eligible Patients Receiving an Implantable Cardioverter Defibrillator:Insights From the National Cardiovascular Data Registry Implantable Cardioverter Defibrillator Registry.JAMA Cardiol,2017,2:561-565.
3 CaritàP,Corrado E,Pontone G,et al.Non-responders to cardiac resynchronization therapy:Insights from multimodality imaging and electrocardiography.A brief review.Int J Cardiol,2016,225:402-407.
4 Das M K,Khan B,Jacob S,et al.Significance of a fragmented QRScomplex versus a Q wave in patients with coronary artery disease.Circulation,2006,113:2495-501.
5 Rattanawong P,T Riangwiwat,N Prasitlumkum,et al.Baseline fragmented QRS increases the risk of major arrhythmic events in Brugada syndrome:Systematic review and meta-analysis.Ann Noninvasive Electrocardiol,2018,23:p-e12507.
6 Das M K,Suradi H,Maskoun W,et al.Fragmented wide QRS on a 12-lead ECG:a sign of myocardial scar and poor prognosis.Circ Arrhythm Electrophysiol,2008,1:258-68.
7 Hudak M,Kerekanic M,Misikova S,et al.The effectiveness of CRTon improvement of survival of heart failure patients in real life clinical settings.Acta Cardiol,2017,72:180-187.
8 Xu Y,Z Qiu,Y Xu,et al.The role of f QRS in coronary artery disease.A meta-analysis of observational studies.Herz,2015,40:8-15.
9 Meng L,Letsas KP,Baranchuk A,et al.Meta-analysis of Fragmented QRS as an Electrocardiographic Predictor for Arrhythmic Events in Patients with Brugada Syndrome.Front Physiol,2017,12:678-683.
10 Zhao L,Lu J,Cui ZM,et al.Changes in left ventricular synchrony and systolic function in dilated cardiomyopathy patients with frag-mented QRS complexes.Europace,2015,17:1712-1719..
11 Assadian M,Tabarzan N,Barzigar A,et al.The role of the fragmented QRS complexes on a routine 12-lead ECG in predicting non-responsiveness to cardiac resynchronization therapy.Anatol JCardiol,2015,15:204-208.
12 Chew DS,Wilton SB,Kavanagh K,et al.Fragmented QRScomplexes after acute myocardial infarction are independently associated with unfavorable left ventricular remodeling.JElectrocardiol,2018,51:607-612.
13林晓明,杨希利,刘鹤龄,等.碎裂QRS波对扩张型心肌病患者预后的预测价值.实用医学杂志,2015,31:225-227.
14吕钢,陈康玉,严激,等.碎裂QRS波对心脏再同步治疗无反应的预测价值.安徽医科大学学报,2015,50:500-503.
15 Stankovic I,Prinz C,Ciarka A,et al.Relationship of visually assessed apical rocking and septal flash to response and long-term survival following cardiac resynchronization therapy(PREDICT-CRT).Eur Heart J Cardiovasc Imaging,2016,17:262-9.
16 Brignole M,Auricchio A,Baron-Esquivias G,et al.2013 ESCGuidelines on cardiac pacing and cardiac resynchronization therapy.Rev Esp Cardiol(Engl Ed),2014,67:58-63.
17 Igarashi M,H Tada,H Yamasaki,et al.Fragmented QRS Is a Novel Risk Factor for Ventricular Arrhythmic Events After Receiving Cardiac Resynchronization Therapy in Nonischemic Cardiomyopathy.J Cardiovasc Electrophysiol,2017,28:327-335.
18 Jackson T,Lenarczyk R,Sterlinski M,et al.Left ventricular scar and the acute hemodynamic effects of multivein and multipolar pacing in cardiac resynchronization.Int J Cardiol Heart Vasc,2018,10:14-19.
19 Zhao L,Lu J,Cui ZM,et al.Changes in left ventricular synchrony and systolic function in dilated cardiomyopathy patients with frag-mented QRS complexes.Europace,2015,17:1712-9.
2 Marzec LN,Peterson PN,Bao H,et al.Use of Cardiac Resynchronization Therapy Among Eligible Patients Receiving an Implantable Cardioverter Defibrillator:Insights From the National Cardiovascular Data Registry Implantable Cardioverter Defibrillator Registry.JAMA Cardiol,2017,2:561-565.
3 CaritàP,Corrado E,Pontone G,et al.Non-responders to cardiac resynchronization therapy:Insights from multimodality imaging and electrocardiography.A brief review.Int J Cardiol,2016,225:402-407.
4 Das M K,Khan B,Jacob S,et al.Significance of a fragmented QRScomplex versus a Q wave in patients with coronary artery disease.Circulation,2006,113:2495-501.
5 Rattanawong P,T Riangwiwat,N Prasitlumkum,et al.Baseline fragmented QRS increases the risk of major arrhythmic events in Brugada syndrome:Systematic review and meta-analysis.Ann Noninvasive Electrocardiol,2018,23:p-e12507.
6 Das M K,Suradi H,Maskoun W,et al.Fragmented wide QRS on a 12-lead ECG:a sign of myocardial scar and poor prognosis.Circ Arrhythm Electrophysiol,2008,1:258-68.
7 Hudak M,Kerekanic M,Misikova S,et al.The effectiveness of CRTon improvement of survival of heart failure patients in real life clinical settings.Acta Cardiol,2017,72:180-187.
8 Xu Y,Z Qiu,Y Xu,et al.The role of f QRS in coronary artery disease.A meta-analysis of observational studies.Herz,2015,40:8-15.
9 Meng L,Letsas KP,Baranchuk A,et al.Meta-analysis of Fragmented QRS as an Electrocardiographic Predictor for Arrhythmic Events in Patients with Brugada Syndrome.Front Physiol,2017,12:678-683.
10 Zhao L,Lu J,Cui ZM,et al.Changes in left ventricular synchrony and systolic function in dilated cardiomyopathy patients with frag-mented QRS complexes.Europace,2015,17:1712-1719..
11 Assadian M,Tabarzan N,Barzigar A,et al.The role of the fragmented QRS complexes on a routine 12-lead ECG in predicting non-responsiveness to cardiac resynchronization therapy.Anatol JCardiol,2015,15:204-208.
12 Chew DS,Wilton SB,Kavanagh K,et al.Fragmented QRScomplexes after acute myocardial infarction are independently associated with unfavorable left ventricular remodeling.JElectrocardiol,2018,51:607-612.
13林晓明,杨希利,刘鹤龄,等.碎裂QRS波对扩张型心肌病患者预后的预测价值.实用医学杂志,2015,31:225-227.
14吕钢,陈康玉,严激,等.碎裂QRS波对心脏再同步治疗无反应的预测价值.安徽医科大学学报,2015,50:500-503.
15 Stankovic I,Prinz C,Ciarka A,et al.Relationship of visually assessed apical rocking and septal flash to response and long-term survival following cardiac resynchronization therapy(PREDICT-CRT).Eur Heart J Cardiovasc Imaging,2016,17:262-9.
16 Brignole M,Auricchio A,Baron-Esquivias G,et al.2013 ESCGuidelines on cardiac pacing and cardiac resynchronization therapy.Rev Esp Cardiol(Engl Ed),2014,67:58-63.
17 Igarashi M,H Tada,H Yamasaki,et al.Fragmented QRS Is a Novel Risk Factor for Ventricular Arrhythmic Events After Receiving Cardiac Resynchronization Therapy in Nonischemic Cardiomyopathy.J Cardiovasc Electrophysiol,2017,28:327-335.
18 Jackson T,Lenarczyk R,Sterlinski M,et al.Left ventricular scar and the acute hemodynamic effects of multivein and multipolar pacing in cardiac resynchronization.Int J Cardiol Heart Vasc,2018,10:14-19.
19 Zhao L,Lu J,Cui ZM,et al.Changes in left ventricular synchrony and systolic function in dilated cardiomyopathy patients with frag-mented QRS complexes.Europace,2015,17:1712-9.