定量碎裂QRS波对扩张型心肌病患者主要不良心血管事件预测价值

    The predictive value of quantitative fragmented QRS waves for major adverse cardiovascular events in patients with dilated cardiomyopathy

      摘要
    • 摘要:
      目的 探讨定量碎裂QRS波在扩张型心肌病患者主要不良心血管事件（MACE）的预测价值。
      方法 共分析扩张型心肌病住院患者345例，根据碎裂QRS波分布导联数量分为三组:无fQRS组（n=180）、SfQRS组（n=88）和MfQRS组（n=77），电话随访终点事件并分析，主要终点是MACE，包括全因死亡、心肌梗死、脑卒中及VT/VF，次要终点为心衰再入院。
      结果 与NonfQRS组比较，SfQRS组、MfQR组的BNP均增加（均P<0.01），且MfQR组高于SfQRS组（P<0.01）。与NonfQRS组比较，SfQRS组、MfQRS组的Q-fQRS均增高（均P<0.01），且MfQR组高于SfQRS组（P<0.01）；与NonfQRS组和SfQRS组比较，MfQRS组的LAD均增高（均P<0.01），但NonfQRS组和SfQRS组之间无统计学差异；MfQRS组的LVEDD、LVESD均增高（均P<0.01），且MfQR组高于SfQRS组（P<0.01）；MfQRS组的LVEF、LVFS均降低（均P<0.01），且MfQR组低于SfQRS组（P<0.01）。在随访期为27（21，31）个月中， 92例患者发生MACE，其中MfQRS组发生MACE概率、全因死亡发生率、VT/VF发生率和心衰再入院发生率明显高于NonfQRS组和SfQRS组（P<0.05，P<0.01），后2组无统计学差异；多变量COX回归分析，MfQRS是MACE、全因死亡、VT/VF、心衰再入院的重要预测因子。在ROC分析中，Q-fQRS AUC为0.746，灵敏度为61.9%，特异度为80.5%；碎裂导联数AUC为0.707，灵敏度为68.1%，特异度为63.2%，Q-fQRS是扩张型心肌病发生MACE的独立预测因子。
      结论 多碎裂QRS波与DCM患者MACE事件相关，定量碎裂QRS波是扩张型心肌病发生MACE的独立预测因子。

       

      Abstract:
      AIM  To explore the prognostic value of quantitative fragmented QRS in predicting major adverse cardiovascular events (MACE) in patients with dilated cardiomyopathy (DCM). ETHODS A total of 345 inpatients with DCM were analyzed and divided into three groups based on the number of fragmented QRS: 180 patients with no fQRS(NonfQRS), 88 patients with a single fQRS(SfQRS) and 77 patients with multiple fQRS(MfQRS). The primary endpoint was MACE, including all-cause mortality, myocardial infarction, stroke, and ventricular tachycardia/ventricular fibrillation (VT/VF), while the secondary endpoint was heart failure readmission.
      RESULTS Compared with the NonfQRS group, BNP levels increased in both the SfQRS and MfQR groups (both P<0.01), with MfQR group being higher than SfQRS group (P<0.01). Compared with the NonfQRS group, the Q-fQRS of the SfQRS group and MfQRS group were both increased (both P<0.01), and the MfQR group was higher than the SfQRS group (P<0.01); Compared with the NonfQRS group and SfQRS group, the LAD of the MfQRS group was increased (both P<0.01), but there was no statistical difference between the NonfQRS group and SfQRS group; The LVEDD and LVESD of the MfQRS group were both increased (both P<0.01), and the MfQR group was higher than the SfQRS group (P<0.01); The LVEF and LVFS of the MfQRS group were both reduced (both P<0.01), and the MfQR group was lower than the SfQRS group (P<0.01). During the follow-up period of 27 (21, 31) months, 92 patients developed MACE. The probability of MACE, all-cause mortality, VT/VF, and readmission to heart failure were significantly higher in the MfQRS group than in the NonfQRS group and SfQRS group (P<0.05, P<0.01), but there was no statistical difference between the latter two groups; Multivariate Cox regression analysis shows that MfQRS is associated with MACE, all-cause mortality VT/VF、 An important predictor of readmission for heart failure. In ROC analysis, the Q-fQRS AUC was 0.746, sensitivity was 61.9%, and specificity was 80.5%; The AUC of fragmented leads is 0.707, the sensitivity is 68.1%, and the specificity is 63.2%. Q-fQRS is an independent predictor of MACE in dilated cardiomyopathy.
      CONCLUSION  Multiple fragmented QRS waves are associated with MACE in DCM patients, and quantitative fragmented QRS serves as an independent predictor of MACE in this population.

       

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