碎裂QRS波与斑点追踪成像在心肌梗死预后中的应用

目的：探讨碎裂QRS波与斑点追踪成像技术在评价心肌瘢痕及心肌梗死预后中的作用。方法纳入2012年1月~2012年12月包头市中心医院急性ST段抬高型心肌梗死（STEMI）患者120例，其中发病时间＜12小时、行急诊PCI或静脉溶栓治疗患者40例（A组）；发病时间＞12小时、行择期PCI治疗40例（B组）；发病时间＞24小时，行药物治疗40例（C组）。分别于发病后4周、8周、12周，应用同步十二导联心电图观察fQRS波群，记录阳性导联数，使用斑点追踪成像分析软件测量心室前壁径向收缩期应变率（RSR）及纵向收缩期应变率（LSR），同时测定左室射血分数（LVEF），以评价心肌瘢痕。比较三组fQRS波群阳性率以及心肌瘢痕的形成情况，并随访6个月内心脏不良事件的发生情况，分析心肌瘢痕的形成与心梗预后有无关联。结果随着治疗时间的延长，三组fQRS波阳性导联数、LSR、RSR及LVEF值均有所改善，治疗12周后A组形成碎裂QRS阳性导联数最少（A组：31，B组：69，C组：96），LSR、RSR及LVEF改善最为明显，B组次之[LSR（A组：34.90%±0.67%，B组：25.48%±0.63%，C组：17.86%±0.54%）；RSR（A组：-20.77%±0.53%；B组：-13.12%±0.47%；C组：-9.10%±0.53%）；LVEF （A组：53.8%±1.5%；B组：43.9%±1.7%；C组：42.3%±1.7%）]，各组间比较差异有统计学意义（P＜0.05）。A组随访期间心脏不良事件发生率（10.0%）远低于B组（30.0%）和C组（62.5%），各组间均有统计学差异（P＜0.05）。结论 fQRS波与心肌瘢痕形成有关，结合斑点追踪技术可评价心肌瘢痕的形成及心功能的恢复情况，并对预后有预测价值。

Application of fragmented QRS wave and speckle tracking imaging in reviewing prognosis of myocardial infarction

Objective To investigate the effects of fragmented QRS wave （fQRS） and speckle tracking imaging （STI） in reviewing myocardial scarring and prognosis of acute myocardial infarction （AMI）.Methods The patients with ST-segment elevation myocardial infarction （STEMI,n=120） were chosen from the Central Hospital of Baotou City from Jan. 2012 to Dec. 2012. All patients were divided into group A （attack time12 h and treated with selected PCI） and group C （attack time〉24 h and treated with drugs, eachn=40）. After attack of AMI for 4 w, 8 w and 12 w, the changes of fQRS were respectively observed and count of positive leads was recorded by using synchronous 12-lead ECG. The changes of RSR and LSR were detected by using STI analysis software, and at the same time LVEF was detected for reviewing myocardial scarring. The positive rate of fQRS and myocardial scarring were compared among 3 groups. The patients were followed up for 6 months for investigating the incidence of major adverse cardiovascular events （MACE） and analyzing the correlation between myocardial scarring and prognosis of AMI.Results As therapeutic time was prolonged, the values of count of fQRS positive leads, LSR, RSR and LVEF were improved. After treatment for 12 w, the count of fQRS positive leads was the lowest in group A （group A： 31, group B： 69, group C： 96）, and improvements of LSR, RSR and LVEF were the most significant in group A and secondly in group B [LSR （group A： 34.90%±0.67%, group B： 25.48%±0.63%, group C： 17.86%±0.54%）; RSR （group A： -20.77%±0.53%, group B： -13.12%±0.47%, group C： -9.10%±0.53%）; LVEF （group A： 53.8%±1.5%, group B： 43.9%±1.7%, group C： 42.3%±1.7%）;P〈0.05]. During follow-up period, the incidence of MACE was 10.0% in group A, which was significantly lower than that in group B （30.0%） and group C （62.5%,P〈0.05）.Conclusion fQRS is correlated to the formation of myocardial scarring, and STI can review myocardial scarring and the recovery of heart function, which has predictive value to the prognosis of AMI.