碎裂QRS波对急性心肌梗死患者早期左室重构及心功能的影响
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摘要
目的探讨碎裂QRS波(fQRS)与急性心肌梗死(AMI)患者早期左室重构及心功能的关系。方法收集我院心脏科监护病房2017年2月—8月确诊为AMI并行经皮冠状动脉介入术(PCI)治疗的患者76例,根据有无fQRS分为fQRS组(29例)和Non-fQRS组(47例),收集患者的临床资料、心电图、实验室检查指标、冠脉造影结果、实时三维彩色超声指标,分析fQRS与基线资料、三维彩色超声结果的关系,同时探讨影响左室重构及心功能的因素。结果与Non-fQRS组相比,fQRS组左室舒张末容积(LVEDV)、左室收缩末容积(LVESV)更大,左室射血分数(LVEF)更小,差异有统计学意义(P<0.05);fQRS组Tmsv 16-SD(%)、Tmsv 16-Dif(%)测值均较Non-fQRS组明显增加,差异有统计学意义(P<0.05);2组间Tmsv 16-SD(ms)、Tmsv 12-SD(ms)、Tmsv 12-SD(%)、Tmsv 6-SD(ms)、Tmsv 6-SD(%)、Tmsv 16-Dif(ms)、Tmsv 12-Dif(ms)、Tmsv 12-Dif(%)、Tmsv 6-Dif(ms)、Tmsv 6-Dif(%)比较差异无统计学意义;Logistic回归分析显示fQRS、Gensini评分均对心功能有影响,fQRS是左室重构的独立危险因素。结论AMI合并fQRS患者的早期左室重构更明显,fQRS可较好地预测左室重构。
Objective To investigate the relationship between fragmented QRS(fQRS) complex and the early leftventricular remodeling or heart function in patients with acute myocardial infarction(AMI). Methods A total of 76 patientswith AMI hospitalized in CCU of the Second Hospital of Tianjin Medical University were enrolled in the study. Patients weredivided into fQRS group(n=29) and non-fQRS group(n=47). The clinical data including ECG, laboratory indicators,coronary angiography results and real-time three-dimensional(RT-3 D) echocardiography parameter were collected in twogroups. The relationship between fQRS and baseline data, fQRS and RT-3 D echocardiography parameter were analyzed. Atthe same time, the influencing factors of left ventricular remodeling and heart function were discussed in the study. Results Compared with non-fQRS group, left ventricular end-diastolic volume(LVEDV) and left ventricular end-systolic volume(LVESV) were significantly higher, and left ventricular ejection fraction(LVEF) was significantly lower in fQRS group(P<0.05). Several three-dimensional parameters including Tmsv16-SD(%) and Tmsv 16-Dif(%) were significantly higher infQRS group than those in non-fQRS group(P<0.05). There were no significant differences in Tmsv 16-SD(ms), Tmsv 12-SD(ms), Tmsv 12-SD(%), Tmsv 6-SD(ms), Tmsv 6-SD(%), Tmsv 16-Dif(ms), Tmsv 12-Dif(ms), Tmsv 12-Dif(%), Tmsv6-Dif(ms) and Tmsv 6-Dif(%) between two groups. Logistic regression analysis showed that fQRS and Gensini scores hadeffects on heart function. At the same time, fQRS was an independent predictor for left ventricular remodeling. Conclusion Left ventricular remodeling is more obvious in patients with acute myocardial infarction complicated with fQRS, and fQRScan predict left ventricular remodeling better.
Objective To investigate the relationship between fragmented QRS(fQRS) complex and the early leftventricular remodeling or heart function in patients with acute myocardial infarction(AMI). Methods A total of 76 patientswith AMI hospitalized in CCU of the Second Hospital of Tianjin Medical University were enrolled in the study. Patients weredivided into fQRS group(n=29) and non-fQRS group(n=47). The clinical data including ECG, laboratory indicators,coronary angiography results and real-time three-dimensional(RT-3 D) echocardiography parameter were collected in twogroups. The relationship between fQRS and baseline data, fQRS and RT-3 D echocardiography parameter were analyzed. Atthe same time, the influencing factors of left ventricular remodeling and heart function were discussed in the study. Results Compared with non-fQRS group, left ventricular end-diastolic volume(LVEDV) and left ventricular end-systolic volume(LVESV) were significantly higher, and left ventricular ejection fraction(LVEF) was significantly lower in fQRS group(P<0.05). Several three-dimensional parameters including Tmsv16-SD(%) and Tmsv 16-Dif(%) were significantly higher infQRS group than those in non-fQRS group(P<0.05). There were no significant differences in Tmsv 16-SD(ms), Tmsv 12-SD(ms), Tmsv 12-SD(%), Tmsv 6-SD(ms), Tmsv 6-SD(%), Tmsv 16-Dif(ms), Tmsv 12-Dif(ms), Tmsv 12-Dif(%), Tmsv6-Dif(ms) and Tmsv 6-Dif(%) between two groups. Logistic regression analysis showed that fQRS and Gensini scores hadeffects on heart function. At the same time, fQRS was an independent predictor for left ventricular remodeling. Conclusion Left ventricular remodeling is more obvious in patients with acute myocardial infarction complicated with fQRS, and fQRScan predict left ventricular remodeling better.
引文
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[3]Michael MA,El Masry H,Khan BR,et al.Electrocardiographic signs of remote myocardial infarction[J].Prog Cardiovasc Dis,2007,50(3):198-208.doi:10.1016/j.pcad.2007.05.003.
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[7]Temiz A,Gazi E,Gungor O,et al.Fragmented QRS and prediction of paroxysmal atrial fibrillation episodes[J].Pak J Med Sci,2014,30(4):862-867.
[8]Morita H,Kusano KF,Miura D,et al.Fragmented QRS as a marker of conduction abnormality and a predictor of prognosis of Brugada syndrome[J].Circulation,2008,118(17):1697-1704.doi:10.1161/circulationaha.108.770917.
[9]St John Sutton MG,Plappert T,Abraham WT,et al.Effect of cardiac resynchronization therapy on left ventricular size and function in chronic heart failure[J].Circulation,2003,107(15):1985-1990.doi:10.1161/01.cir.0000065226.24159.e9.
[10]Kanzaki H.Mechanical dyssynchrony is not everything of substrate but is essential for cardiac resynchronization therapy.Is assessment of mechanical dyssynchrony necessary in determining CRTindication?(Pro)[J].Circ J,2011,75(2):457-464.
[11]Davies MJ.The cardiomyopathies:an overview[J].Heart,2000,83(4):469-474.
[12]Uslu N,Gul M,Cakmak HA,et al.The assessment of relationship between fragmented QRS complex and left ventricular wall motion score index in patients with ST elevation myocardial infarction who underwent primary percutaneous coronary intervention[J].Ann Noninvasive Electrocardiol,2015,20(2):148-157.doi:10.1111/anec.12180.
[13]Gungor B,Ozcan KS,Karatas MB,et al.Prognostic value of QRSfragmentation in patients with acute myocardial infarction:a metaanalysis[J].Ann Noninvasive Electrocardiol,2016,21(6):604-612.doi:10.1111/anec.12357.
[14]Kapetanakis S,Kearney MT,Siva A,et al.Real-time threedimensional echocardiography:a novel technique to quantify global left ventricular mechanical dyssynchrony[J].Circulation,2005,112(7):992-1000.doi:10.1161/circulationaha.104.474445.
[15]Ko JS,Jeong MH,Lee MG,et al.Left Ventricular dyssynchrony after acute myocardial infarction is a powerful indicator of left ventricular remodeling[J].Korean Circ J,2009,39(6):236-242.doi:10.4070/kcj.2009.39.6.236.
[16]王丽萍.斑点追踪成像技术及实时三维超声心动图评价冠心病患者PCI或CABG术前后左室心功能变化[D].重庆:第三军医大学,2012.Wang LP.Evaluation of the left ventricular function in patients with coronary heart disease before and after PCI or CABGusing STI and RT-3DE[D].Chongqing:Third Military Medical University,2012.
[2]Fox KA,Goodman SG,Anderson FA Jr,et al.From guidelines to clinical practice:the impact of hospital and geographical characteristics on temporal trends in the management of acute coronary syndromes.The Global Registry of Acute Coronary Events(GRACE)[J].Eur Heart J,2003,24(15):1414-1424.
[3]Michael MA,El Masry H,Khan BR,et al.Electrocardiographic signs of remote myocardial infarction[J].Prog Cardiovasc Dis,2007,50(3):198-208.doi:10.1016/j.pcad.2007.05.003.
[4]Cheema A,Khalid A,Wimmer A,et al.Fragmented QRS and mortality risk in patients with left ventricular dysfunction[J].Circ Arrhythm Electrophysiol,2010,3(4):339-344.doi:10.1161/circep.110.940478.
[5]Pietrasik G,Zareba W.QRS fragmentation:diagnostic and prognostic significance[J].Cardiol J,2012,19(2):114-121.
[6]Basaran Y,Tigen K,Karaahmet T,et al.Fragmented QRScomplexes are associated with cardiac fibrosis and significant intraventricular systolic dyssynchrony in nonischemic dilated cardiomyopathy patients with a narrow QRS interval[J].Echocardiography,2011,28(1):62-68.doi:10.1111/j.1540-8175.2010.01242.x.
[7]Temiz A,Gazi E,Gungor O,et al.Fragmented QRS and prediction of paroxysmal atrial fibrillation episodes[J].Pak J Med Sci,2014,30(4):862-867.
[8]Morita H,Kusano KF,Miura D,et al.Fragmented QRS as a marker of conduction abnormality and a predictor of prognosis of Brugada syndrome[J].Circulation,2008,118(17):1697-1704.doi:10.1161/circulationaha.108.770917.
[9]St John Sutton MG,Plappert T,Abraham WT,et al.Effect of cardiac resynchronization therapy on left ventricular size and function in chronic heart failure[J].Circulation,2003,107(15):1985-1990.doi:10.1161/01.cir.0000065226.24159.e9.
[10]Kanzaki H.Mechanical dyssynchrony is not everything of substrate but is essential for cardiac resynchronization therapy.Is assessment of mechanical dyssynchrony necessary in determining CRTindication?(Pro)[J].Circ J,2011,75(2):457-464.
[11]Davies MJ.The cardiomyopathies:an overview[J].Heart,2000,83(4):469-474.
[12]Uslu N,Gul M,Cakmak HA,et al.The assessment of relationship between fragmented QRS complex and left ventricular wall motion score index in patients with ST elevation myocardial infarction who underwent primary percutaneous coronary intervention[J].Ann Noninvasive Electrocardiol,2015,20(2):148-157.doi:10.1111/anec.12180.
[13]Gungor B,Ozcan KS,Karatas MB,et al.Prognostic value of QRSfragmentation in patients with acute myocardial infarction:a metaanalysis[J].Ann Noninvasive Electrocardiol,2016,21(6):604-612.doi:10.1111/anec.12357.
[14]Kapetanakis S,Kearney MT,Siva A,et al.Real-time threedimensional echocardiography:a novel technique to quantify global left ventricular mechanical dyssynchrony[J].Circulation,2005,112(7):992-1000.doi:10.1161/circulationaha.104.474445.
[15]Ko JS,Jeong MH,Lee MG,et al.Left Ventricular dyssynchrony after acute myocardial infarction is a powerful indicator of left ventricular remodeling[J].Korean Circ J,2009,39(6):236-242.doi:10.4070/kcj.2009.39.6.236.
[16]王丽萍.斑点追踪成像技术及实时三维超声心动图评价冠心病患者PCI或CABG术前后左室心功能变化[D].重庆:第三军医大学,2012.Wang LP.Evaluation of the left ventricular function in patients with coronary heart disease before and after PCI or CABGusing STI and RT-3DE[D].Chongqing:Third Military Medical University,2012.