扩张型心肌病患者碎裂QRS波与预后的关系  

Relationship between fragmented QRS and prognosis in patients with dilated cardiomyopathy

作　　者：陈刚[1] 黄婷[1] 杨锴[1] 

机构地区：[1]武汉市中心医院心血管内科,武汉430014

出　　处：《临床心血管病杂志》2014年第11期990-993,共4页Journal of Clinical Cardiology

摘　　要：目的:评价在扩张型心肌病患者中碎裂QRS波(fragmented QRS,fQRS)与预后的关系。方法:纳入扩张型心肌病患者178例,按是否伴有碎裂QRS波分为fQRS组(62例)和正常组(116例),进行随访,比较两组终点事件(因心力衰竭再次入院和心源性死亡)发生率,通过Cox多元回归分析fQRS与终点事件的关系。结果:与正常组相比,fQRS组患者的QT间期较长[(387.8±25.6)ms:(375.7±30.2)ms,P<0.01],左室射血分数(LVEF)较低[(29.2±6.3)%:(35.6±7.5)%,P<0.01],左室舒张末期内径较大[(70.2±3.5)mm:(68.4±4.8)mm,P=0.01],N末端B型脑钠肽前体(NT-proBNP)浓度较高[(3644±178)pg/dl:(3270±213)pg/dl,P<0.01]和NYHA分级较高(Ⅱ/Ⅲ/Ⅳ:12/23/37:32/68/16,P<0.01];平均随访(15.2±3.4)个月,fQRS组终点事件发生率显著高于正常组(72.5%∶42.2%,P<0.01);Cox多元回归分析表明fQRS、LVDD、LVEF和NTproBNP是患者终点事件发生的独立危险因素。结论:fQRS与扩张型心肌病患者的预后密切相关,是患者预后的重要危险因素。Objective：To assess the relationship between fragmented QRS（fQRS）and prognosis in patients with dilated cardiomyopathy（DCM）.Method：A total of 178 patients with DCM were divided into fQRS group（n=62）and control group（n=116）,then difference in combined end-events（re-hospital for heart failure and cardiac-caused mortality）was compared between two groups in follow-up period,and the relation between fragmented QRS（fQRS）and prognosis was estimated using Cox proportional-hazards models.Result：Compared to the control group,the fQRS group showed longer QT duration[（387.8±25.6）ms vs（375.7±30.2）ms,P〈0.01],reduced LVEF[（29.2±6.3）%vs（35.6±7.5）%,P〈0.01],greater LVDD[（70.2±3.5）mm vs（68.4±4.8）mm,P=0.01],higher NT-proBNP level[（3644±178）pg/dl vs（3270±213）pg/dl,P〈0.01]and higher NYHA grade（Ⅱ/Ⅲ/Ⅳ：12/23/37 vs 32/68/16,P〈0.01）.Average follow-up to（15.2±3.4）months,the incidence of combined end-events was significant higher in the fQRS group than the control group（（72.5%vs 42.2%,P〈0.01）,and the results of Cox proportional-hazards models displayed that fQRS,LVDD,LVEF and NT-proBNP were independent risk factors of prognosis in patient with DCM.Conclusion：There is a close relationship between fragmented QRS and prognosis in DCM patients,and the fragmented QRS was a critical risk factor of prognosis for these patient populations.

关 键 词：扩张型心肌病 碎裂QRS波 心力衰竭 心源性死亡 

分 类 号：R542.2[医药卫生—心血管疾病]