碎裂宽QRS波对急性心肌梗死患者的预后价值评估

目的探讨碎裂宽QRS波(fragmented wide QRS,f WQRS)对急性心肌梗死患者预后的预测价值。方法选取解放军总医院急性心肌梗死患者300例,根据入院12导联同步心电图是否出现f QRS波群分为f QRS组(205例)及非f QRS组(95例),比较两组患者的基线情况、心电特征值及超声结果。随访12个月,观察两组患者的心血管事件发生情况。并对12导联同步心电图出现f QRS波群的患者分为宽f QRS组与窄f QRS组行亚组分析,探讨宽f QRS与急性心肌梗死患者预后的关系。结果f QRS组与非f QRS组心电各项特征值比较,QRS时限延长(93.12±11.74)ms vs(89.15±11.15)ms,P0.05]、QTc间期延长(448.39±35.18)ms vs(439.93±29.79)ms,P0.05]。心脏超声结果显示,f QRS组EF值更小(47.41±9.12)vs(50.44±7.84),P0.05],心功能较差。随访期间两组心血管事件发生情况并未表现出明显的统计学差异。亚组分析显示,宽f QRS组与窄f QRS组比较,宽f QRS组心源性死亡发生率高于窄f QRS组(P0.05),宽f QRS组生存时间明显短于窄f QRS组(13.02±5.00)个月vs(16.81±4.31)个月,P0.01]。结论宽f QRS波在体表心电图中出现,对远期再发心血管事件有较高的预警价值,可以做为预测心源性死亡的可靠指标。

Value of fragmented wide QRS wave to evaluate the prognosis of patients with acute myocardial infarction

Objective To investigate the predictive value of fragmented wide QRS complex (fWQRS) on for the prognosis of patients with acute myocardial infarction (AMI). Methods 300 patients with AMI in PLA general hospital were enrolled in the study,and divided into two groups: fQRS group and non- fQRS according to the presence of fQRS complex. Compare the baseline, ECG characteristic value,the ultrasound results of the patients between the two groups. Cardiac events were recorded in all patients during 12 months follow-up. We divided patients of fQRS group into two subgroups: wide QRS subgroup and narrow wide QRS subgroup according to the duration of fQRS complex. And we studied the relationship between fragmented wide QRS complex and the prognosis of patient with AMI. Results The QRS duration and QT interval in the group of fQRS was longer than non-fQRS (P <0.05). The left ventricular ejection fraction (LVEF)in the fQRS group was lower than the non-fQRS group (P < 0.05). In the subgroup,there was statistically significant difference in the mortality in follow-up period between the fragmented wide QRS group and the fragmented narrow QRS group (P < 0.05),and the survival time in the fragmented wide QRS group was shorter than the fragmented narrow QRS group (P < 0.01). Conclusion fQRS in body surface electrocardiogram of patients with AMI is a sign of increased cardiovascular events. It has a significant predictive value for the long-term prognosis and can serve as an indicators for cardiac death.