心肌梗死患者碎裂QRS波群分析

急性心肌梗死是临床上的一种常见急症。及时、正确地诊断和治疗对降低死亡率、改善预后至关重要。碎裂QRS波群是冠心病心肌梗死患者心电图新出现或已经存在QRS波群的3相波（RSR’型）或多相波,并排除了完全性或不完全性束支传导阻滞例。     

宽QRS波群心动过速、右束支传导阻滞、再发心肌梗死

宽QRS波群心动过速是常见临床急症,因有陈旧性心肌梗死、束支传导阻滞以宽QRS波群心动过速来诊的急性冠状动脉综合征的患者,更增加了心电图分析的复杂性。这次教学查房结合1例"宽QRS波群心动过速、右束支传导阻滞、再发心肌梗死"诊治过程中研究生提出的有关临床心电图问题加以讨论。杨医师(研究生)患者男性,83岁。因"胸痛5年,心悸3d,加重3h"入院。患者5年前因胸痛于我院诊断"急性下壁心肌梗死"。出院后     

室性期前收缩揭示左束支传导阻滞掩盖的陈旧性下壁心肌梗死1例

患者男性，70岁。1年前有急性下壁心肌梗死合并右心室心肌梗死史(经临床血清心肌酶谱及心电图证实)。近期门诊随访，常规心电图(图1)示窦性心律，心率98次／min，P—R间期0．174s，QRS时间0．15s，V1导联呈rS或QS型，Vd导联呈宽大R型，为完全性左束支传导阻滞；长aVF导联中R3、R8及I、Ⅱ、Ⅲ导联中R2略为提前，QRS波群时间0．1s，Ⅲ导联呈Qr型，II、aVF导联呈QR型，Q波时间为0．04—0．06s。QRS波群与其前P波的间期短于窦性时的P—R间期。可能为来自左心室的期前收缩与来自右束支正常传导的室性融合波群，使QRS波群“正常化”，并揭示下壁心肌梗死。心电图诊断：窦性心律，完全性左束支传导阻滞，室性期前收缩或室性融合波群揭示陈旧性下壁心肌梗死。     

急性心肌梗死患者碎裂QRS波与室性心律失常及左心室收缩功能的关系

目的研究急性心肌梗死患者碎裂QRS波与室性心律失常及左心室收缩功能的关系。方法纳入2016年3月至2018年3月于新疆生产建设兵团第七师医院心血管内科收治的急性心肌梗死患者117例为研究对象。将患者按照心电图QRS波形态的不同分为三组:A组(碎裂QRS波)41例,B组(病理性Q波)40例,C组(碎裂QRS波合并病理性Q波)36例。分别采用动态心电图、心脏彩超检测三组患者室性心律失常发生情况以及左室射血分数、左心室舒张末期内径水平,同时比较三组患者住院期间主要心脏不良事件发生情况。结果三组Ⅰ级、Ⅱ级、Ⅲ级室性心律失常发生率比较差异均不显著(P均0.05);A组、C组ⅣA级、ⅣB级、Ⅴ级室性心律失常发生率相比B组均较高(P均0.05)。A组、C组左室射血分数水平相比B组明显较低,而左心室舒张末期内径水平明显较高(P均0.05)。A组、B组、C组住院期间心源性死亡、心源性休克、急性左心衰发生率比较差异均不显著(P均0.05)。结论急性心肌梗死患者碎裂QRS波与室性心律失常、左心室收缩功能密切相关,可为诊断和预后评估提供参考依据。     

急性下壁心肌梗死aVR导联QRS波的形态分析

目的探讨下壁心肌梗死时心电图aVR导联QRS波群形态的改变。方法分析89例急性下壁心肌梗死患者心梗前、后以及1年后的心电图和100例经冠状动脉造影证实的无冠心病患者的心电图,分析aVR导联QRS波群形态的变化。结果急性下壁心肌梗死前和无冠心病患者的心电图aVR导联QRS波群多呈q(Q)r型(89.2%),少数呈QS型(10.8%);下壁心肌梗死后及1年后心电图aVR导联QRS波群多呈rs(S)型(86.21%),少数呈QS型(12.77%),极少数呈Qr型(1.02%)。结论下壁心肌梗死后心电图aVR导联QRS波群多呈r(sS)型。     

碎裂QRS波群对急性心肌梗死的诊断和预后预测价值的研究进展

碎裂QRS波群是12导联普通心电图心室除极的异常电生理活动指标,其发生与心肌电活动紊乱有关。急性心肌梗死是临床上常见的心血管急症,研究发现,碎裂QRS波群的出现对急性心肌梗死的诊断和预后情况的预测密切相关,现综述其研究进展。     

急性心梗心电图QRS波终末变形与左室功能变化的研究

目的探讨急性心肌梗死患者心电图QRS波终末变形情况与左心室功能变化的关系。方法根据入院心电图将急性心梗患者分成QRS终末变形阳性(QRS+)组(n=22)与QRS终末变形阴性(QRS-)组(n=46),于经皮冠状动脉介入术后2周与6个月时行超声心动图检查。结果术后6个月时QRS-组左心室舒张末期容积指数(LVEDVI)、左室收缩末期容积指数(LVESVI)及室壁活动异常积分(VWMA)明显小于QRS+组p<0.05),而左室射血分数(LVEF)显著高于QRS+组(p<0.05)。结论心电图QRS终末变形可作为急性心梗后左室重构和左室功能变化的预测因子之一。     

12导联QRS总振幅记分法标准诊断左心室肥大的价值

心电图是临床诊断左心室肥大的常用方法之一。为了提高其诊断的准确性,1985年国内黄大显等提出了改良记分法标准,1988年杨天和等报道应用12导联QRS总振幅(QRS)标准,1997年都星娅等报道QRS结合ST-T改变及电轴左偏诊断左室肥大。笔者综合以上几种标准,提出QRS记分法标准,并与超声心动图作对照,以检验以上3种标准诊断左心室肥大的准确性。1　对象与方法1.1　对象共246例,选自我院心脏科1994年接受二维超声心动图检查且符合下述条件者:1年龄在15岁以上者;2超声心动图质量满意;3同时记录常规12导联心电图,除外心肌梗死、完全性左或右束支…     

扩张型心肌病超声心动图与心电图的相关性

目的 观察扩张型心肌病超声心动图的主要指标改变与心电图QRS波时限的关系.方法 选取经超声心动图确诊为扩张型心肌病的患者58例,采用超声心动图测定相关数据,将左心室射血分数作为自变量,然后分别以左心室收缩末内径、左心室舒张末内径、QRS波群时限作为因变量进行直线相关分析;然后以左心室收缩末内径、左心室舒张末内径作为自变量,以QRS波群时限为因变量进行直线相关分析.结果 采用直线相关分析得出,左心室内径大小与QRS波群时限呈正相关关系（y=38.379＋0.256x;y=28.946＋0.051x）;左心室射血分数与左心室内径大小呈负相关关系（y=48.723-0.275x;y=50.248-0.341x）,与QRS波群时限呈负相关关系（y=40.449-0.086x）.结论 扩张型心肌病患者随着左心室内径的增大而射血分数变小、QRS波群时限相应延长;心电图对于扩张型心肌病的诊断具有重要的辅助意义.     

碎裂QRS波在急性心肌梗死诊断中的价值

目的探讨心电图碎裂QRS波(fQRS)对急性心肌梗死(AMI)的诊断价值。方法回顾分析200例经冠状动脉造影确诊的急性心肌梗死患者,根据心电图QRS波形态分为病理性Q波、碎裂QRS波、病理性Q波合并碎裂QRS波三组,根据心肌梗死的不同部位及不同类型进行统计分析。结果 200例急性心肌梗死患者心电图出现病理性Q波166例,出现碎裂QRS波105例,出现病理性Q波和碎裂QRS波87例。对急性心肌梗死诊断的敏感性,病理性Q波、碎裂QRS波、病理性Q波和碎裂QRS波两者联合分别为83.0%、52.5%和43.5%;诊断的特异性分别为90.0%、87.0%、99.0%。结论碎裂QRS波诊断急性心肌梗死的敏感性、阴性预测值明显低于病理性Q波,其特异性和阳性预测值略低于病理性Q波,两者结合诊断急性心肌梗死的特异性和阳性预测值较高。     

QRS记分与陈旧性心肌梗死左室功能的关系

为评价常规心电图ＱＲＳ记分与陈旧性心肌梗死者左室功能的关系，我们对５２例陈旧性心肌梗死者的ＱＲＳ记分与平衡法核素血池测得的ＬＶＥＦ，ＰＥＲ，ＰＥＲ，１／３ＥＦ，１／３ＦＲ，１／３ＥＲ，１／３ＥＦ进行相关分析，发现ＱＲＳ记分不仅与反映收缩功能的ＬＶＥＦ，ＰＥＲ，１／３ＥＦ，１／３ＥＲ明显负相关，而且与反映舒张功能的ＰＥＲ，１／３ＦＲ，１／３ＥＦ明显负相关，结果提示ＱＲＳ记分可用于估测陈旧性心肌梗死的     

Use of QRS scoring and thallium-201 scintigraphy to assess left ventricular function after myocardial infarction

To determine the usefulness of the QRS scoring system in predicting left ventricular function, and the correlation between the QRS score, left ventricular ejection fraction, and the size of infarction, patients with acute or chronic infarction were studied by means of 12-lead electrocardiography, rest thallium-201 scintigraphy, and radionuclide angiography.

In patients with acute infarction there was a statistically significant correlation between the QRS score and the left ventricular ejection fraction (n = 28, r = −0.61, p < 0.001), between the thallium score (as a measure of the extent of necrosis) and the left ventricular ejection fraction (n = 21, r = 0.70, p < 0.001), and between the QRS score and the thallium score (n = 22, r = −0.65, p < 0.001). A QRS score of 2 or less separated patients with left ventricular ejection fraction of 40% or greater from those with lower left ventricular ejection fraction (p < 0.01).

In patients with chronic infarction there was a wide scatter of ejection fraction for any given QRS score (n = 41, r = −0.51). In a subset of patients with chronic infarction before they underwent coronary artery bypass, there was still a fair correlation between thallium score and left ventricular ejection fraction (n = 15, r = 0.61, p < 0.02) but not between thallium score and QRS score (r = 0.03, p > 0.05). In addition, in these patients with chronic infarction who underwent coronary revascularization, there was still a fair correlation between the postoperative thallium score and the postoperative left ventricular ejection fraction (r = 0.75, p < 0.05) but not between the postoperative thallium score and the postoperative QRS score (r = 0.02, p > 0.05) or between the QRS score and the ejection fraction (r = 0.24, p > 0.05).

The size of the defect appears related to the left ventricular ejection fraction in both patients with acute infarction and those with chronic infarction. The QRS scoring system in patients with acute infarction and the size of the thallium defect in patients with acute or chronic infarction can categorize patients into those who have a low, moderate, and normal ejection fraction.     

心电图QRS记分与左室功能及冠状动脉病变关系的探讨

对２１例做过左室和冠状动脉造影的首次发生Ｑ波型急性前壁或下壁心肌梗塞患者采用Ｗａｇｎｅｒ心电图记分法进行心电图ＱＲＳ记分。结果显示：ＱＲＳ记分分别与左室射血分数和左室壁运动记分呈显著负相关和正相关（ｒ值分别为－０．８７和０．８０，Ｐ均＜０．０１）；单支和多支血管病变者ＱＲＳ记分无显著性差异（５．７７±２．９５ｖｓ７．１２±３．６０，Ｐ＞０．０５）；ＱＲＳ记分与冠状动脉记分无相关性（ｒ＝０．０９，Ｐ＞０．０５）。提示简便的ＱＲＳ记分法可以较好地反映急性心肌梗塞患者的左室功能。     

Extension of necrosis and left ventricular function in recent myocardial infarct. Correlation between a QRS scoring system and various echocardiographic indexes

The purpose of this study was to evaluate the extension of myocardial necrosis and the impairment of left ventricular function in patients with recent myocardial infarction by means of the standard 12-lead ECG. Then, we tried to correlate the QRS scoring system proposed by Wagner and coll. with some indexes obtained from a M-Mode and Two-Dimensional echocardiographic examination (echo-score, number of compromised areas, E-septum separation and left ventricular ejection fraction) in a group of 105 pts. (mean age 61.54 +/- 9.66 SD years). Patients were divided into three groups: 47 with anterior infarction, 45 with inferior infarction and 13 with anterior and inferior infarction. A statistically significant correlation was found between the QRS scoring system and (a) the infarct size (r between ECG-score and echo-score = 0.40, p less than 0.001; r between ECG-score and compromised areas = 0.47, p less than 0.001) and (b) left ventricular ejection fraction (r = -0.48, p less than 0.001), measured echocardiographically, particularly in pts. with anterior infarction. No correlation was found with the E-septum separation. In conclusion, the correlation between QRS scoring system and echo indexes appeared statistically significant, even if minimally applicable to single cases.     

QRS记分法评价老年心肌梗塞患者的左室功能

为评估常规心电图ＱＲＳ记分法评价老年心肌梗塞患者的左室收缩及舒张功能的价值，将常规心电图测得的老年急性心肌梗塞（ｎ＝６７）及陈旧性心肌梗塞（ｎ＝３２）的ＱＲＳ记分与９９ｍＴｃＭＩＢＩＳＰＥＣＴ心肌显像检测的心肌坏死、心肌疤痕节段数及平衡法核素心血池显像测得的左室射血分数（ＬＶＥＦ）、高峰射血率（ＰＥＲ）、１／３射血分数（１／３ＥＦ）、１／３充盈率（１／３ＦＲ）、高峰充盈率（ＰＦＲ）、１／３射血率（１／３ＥＲ）、１／３充盈分数（１／３ＦＦ）进行相关分析。发现ＱＲＳ记分与急性心肌梗塞者心肌坏死节段数及陈旧性心肌梗塞者的心肌疤痕节段数显著相关，ｒ分别为０．７８，０．６６，Ｐ均＜０．０００１；与反映收缩功能的ＬＶＥＦ、ＰＥＲ、１／３ＥＦ、１／３ＥＲ呈明显负相关，ｒ分别为－０．７３和－０．８６，－０．５５和－０．７３，－０．３６和－０．５５，－０．６５和－０．７７，Ｐ均＜０．０５；与反映舒张功能的ＰＦＲ、１／３ＦＲ、１／３ＦＦ亦呈明显相关，ｒ分别为－０．４５和０．４１，－０．４９和－０．５２，－０．３８和－０．３６，Ｐ均＜０．０５。说明ＱＲＳ记分可用于估测心肌梗塞面积、左室收缩及舒张功能。     

心肌梗塞合并室壁瘤患者心功能的评价

对29例心肌梗塞合并室壁瘤和38例未合并室壁瘤病人的二维超声心动图、心电图、X线胸片和临床心功能的对照分析结果表明:(1)室壁瘤组与无室壁瘤组,临床心功能≥Ⅱ级者分别占90％与55％,EF值分别为43Z±12％与65±11％(P<0.01),表明心功能不全是室壁瘤病人常见的并发症;(2)EF值与QRS记分、壁瘤范围均呈负相关,r分别=-0.42及-0.59(P分别<0.01及<0.005),且壁瘤范围又与ORS记分呈正相关,r=0.33(P<0.05),说明梗塞面积大,壁瘤范围亦大,而心功能则差;(3)EF值与抬高的ST段≥2mm的导联数或∑ST未显示明显的关系。     

Use of the QRS scoring system in the early estimation of myocardial infarct size following reperfusion

While the QRS scoring system has been established as a convenient tool for estimating infarct size in nonreperfused patients during the chronic stage of myocardial infarction, its applicability to reperfused patients in the acute stage has not been established. To investigate whether infarct size could be estimated by the QRS scoring system soon after reperfusion, we evaluated QRS scores obtained serially 6 hours to 1 month after reperfusion, total creatine kinase release, and left ventricular ejection fraction in 126 patients with acute myocardial infarction who underwent successful reperfusion therapy. A significant correlation was observed between the QRS score obtained after 6 hours and that obtained after 1 month (r = .89). The QRS scores obtained after 6 hours and 1 month were significantly correlated with total creatine kinase release (r = −.65 and r = −.75, respectively) and left ventricular ejection fraction (r = .62 and r = .76, respectively). Thus, the QRS scoring system can be used as a simple and economical method for estimation of infarct size soon after reperfusion.     

CRT术后QRS波时限改变对左心功能的影响

目的 观察顽固性充血性心力衰竭(CHF)患者心脏再同步化治疗(CRT)术后QRS波时限改变及其对左心功能的影响.方法 60例患者接受CRT术,心功能(NYHA分级)Ⅲ～Ⅳ级,左室射血分数(LVEF)11%～35%(27.15±6.35%),左室舒张末期内径(LVEDd)60～106mm(75.35±11.01mm),Q...     

Comparison of a QRS scoring system for estimating acute infarct size with radionuclide left ventriculography

A QRS scoring system was compared with left ventricular ejection fraction (LVEF) in 40 patients enrolled in the Multicenter Post Infarction Program. A poor correlation was found between these two parameters. Possible reasons for these findings include the fact that the radionuclide studies were performed at several institutions or that there was a mean interval of 6 days between the time of the ECG and the radionuclide studies. It was determined that the ECGs could be scored by inexperienced scorers. The utility and limitation of the QRS scoring system for prediction of LVEF need further evaluation, particularly if it is to be applied to a multicenter study.     

Evaluation of methods of measurement and estimation of left ventricular function after acute myocardial infarction

Using multiple gated cardiac blood pool imaging and single-plane ventriculography from cardiac catheterization, 2 independent measures of left ventricular (LV) ejection fraction (EF) were determined in each of 21 patients. Patients were seen 2 to 6 weeks after their first acute myocardial infarction and were free of electrocardiographic evidence of conduction abnormalities and left or right ventricular hypertrophy. Differences between the 2 measures of LVEF were examined and then compared with the extent of myocardial necrosis estimated from the standard 12-lead electrocardiogram using the complete 54-criteria/32-point Selvester QRS scoring system. Regression analysis yielded an r value of 0.81 (SEE = 8.05) for the overall relation between the 2 measures of LVEF. Correlation coefficients of -0.70, -0.66 and -0.72 were obtained for the relations of radionuclide LVEF, catheterization LVEF and the mean of these 2 determinations, respectively, compared with QRS score. A QRS score 4 or less achieved 100% specificity and that of 8 or less 100% sensitivity for predicting an LVEF greater than 40%. Thus, the Selvester QRS scoring system may be of value in identifying patients with or without markedly impaired LVEF. This risk stratification may be important in reaching optimal postinfarction therapeutic decisions.