碎裂QRS波群对非ST段抬高型急性心肌梗死的诊断和预后判断的临床价值

    Diagnostic and prognostic value of fragmented QRS complex in patients with non-ST-elevation myocardial infarction

    • 摘要: 目的 探讨静息12导联心电图碎裂QRS波群(fragmented QRS complex,fQRS)对非ST段抬高型急性心肌梗死(non-ST elevated myocardial infarction,NSTEMI)的诊断和预后判断的临床价值。 方法 分析了长江航运总医院心内科2012~2014年所有确诊为NSTEMI的患者,并将所有患者的临床特点、实验室检查、12导联心电图、心脏肌钙蛋白I(cTnI)、超声心动图及冠状动脉造影等进行统计分析。在286例符合入选标准的NSTEMI患者中,根据入院72 h内静息12导联心电图表现分为fQRS波者85例、病理性Q波者62例、fQRS波并发病理性Q波者103例,另外有36例为单纯ST-T改变,对比分析fQRS波群与病理性Q波在NSTEMI患者中的发生率,同时对这些患者进行1年随访,观察其室性心律失常、心力衰竭、心脏性死亡发生情况。 结果 在NSTEMI患者中,fQRS波群、病理性Q波诊断NSTEMI的灵敏度,分别为65.7%、57.7%,fQRS波灵敏度高于病理性Q波(P<0.05);两者平行试验诊断NSTEMI的灵敏度为87.4%,显著高于单纯fQRS波和病理性Q波(均P<0.01)。1年随访期间,fQRS波阳性组室性心律失常、心力衰竭及心脏性死亡的发生率均显著高于fQRS波阴性组(均P<0.05),特别是室性心律失常发生率尤为显著。 结论 在NSTEMI患者中,fQRS波是心电图检查中一个有力的诊断线索,同时也是预测短期心脏性事件的可靠标志。

       

      Abstract: AIM To investigate the diagnostic and prognostic value of fragmented QRS(fQRS) complex in patients with non-ST-elevated myocardial infarction(NSTEMI). METHODS We analyzed the clinical characteristics and results of laboratory examination, 12-lead electrocardiogram(ECG), cardiac troponin I(cTnI), ultrasound cardiogram(UCG) and coronary angiography(CAG) in 286 patients with confirmed NSTEMI in our hospital from January 2012 to April 2014. According to the results of resting 12-lead ECG within 72 h of hospitalization, 85 patients had fQRS complex, 62 pathologic Q-wave, 103 fQRS complex combined with pathologic Q-wave and 36 with only ST-T changes. We studied the incidence rate, sensitivity of fQRS complex and pathologic Q-wave in these NSTEMI patients. All patients were followed for 1 year to observe the incidence of cardiac events. RESULTS For NSTEMI diagnosis, the sensitivity in fQRS complex was higher than in pathologic Q-wave(65.7% vs. 57.7%, P<0.05). Sensitivity in the parallel test was 87.4%, significantly higher than in fQRS complex or pathologic Q-wave(P<0.01). Cardiac events of fQRS(+) group were significantly higher than those of fQRS(-) group after 1 year follow-up. CONCLUSION fQRS complex is a good diagnostic clue in ECG for NSTEMI and is a reliable indicator for short-term cardiac events in NSTEMI patients.

       

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