陈旧性心肌梗死患者心电图碎裂QRS波的特点及其联合可溶性ST2对远期预后的预测价值  

Characteristics of Fragmented QRS in Patients with Old Myocardial Infarction and Combined Application of Fragmented QRS and Soluble Suppression of Tumorigenicity 2 for Prognosis Assessment

作　　者：梁拓 刘三龙 吕金兰[3] 陈丽竹 高惠宽[1] 刘霄燕 于善栋 张鹤萍[1] LIANG Tuo;LIU Sanlong;LYU Jinlan;CHEN Lizhu;GAO Huikuan;LIU Xiaoyan;YU Shandong;ZHANG Heping(Department of Cardiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Cardiology,NO.3 People’s Hospital of Liaocheng,Liaocheng 252000,Shandong,China;Department of Electrocardiogram,People’s Hospital of Liaocheng,Liaocheng 252000,Shandong,China)

机构地区：[1]首都医科大学附属北京友谊医院心内科,北京市100050 [2]聊城市第三人民医院心内科,山东聊城252000 [3]聊城市人民医院心电图室,山东聊城252000

出　　处：《中国分子心脏病学杂志》2022年第6期5017-5022,共6页Molecular Cardiology of China

基　　金：北京市临床重点专科项目(京卫医[2018] 204号)。

摘　　要：目的 探讨陈旧性心肌梗死(old myocardial infarction,OMI)患者心电图出现碎裂QRS(fragmented QRS,fQRS)波的特点,及fQRS联合可溶性生长刺激表达基因2蛋白(soluble suppression of tumorigenicity 2,sST2)对患者心血管事件的预测作用。方法 纳入2014年3月至2018年3月住院并接受冠脉造影检查的OMI患者,收集患者基线资料,记录患者入院心电图有无fQRS波,根据冠脉造影结果计算Gensini评分并检测sST2水平。出院后随访3年,记录患者心源性死亡发生情况,logistic回归分析OMI患者出现主要心血管不良事件(major adverse cardiovascular events,MACEs)的危险因素。受试者工作特征(receiver operating characteristic,ROC)曲线分析fQRS、sST2单独及联合应用对OMI患者远期预后的预测价值。结果 共纳入338例患者,其中fQRS组180例(53.3%),无fQRS组158例(46.7%)。多因素logistic回归分析显示高sST水平(OR=1.010,95%CI:1.002~1.019,P=0.011)和Gensini评分(OR=1.012,95%CI:1.001~1.023,P=0.040)的患者更易出现fQRS。随访3年时45例患者出现MACEs事件,心电图存在fQRS波,sST水平升高,高Gensini评分和既往合并糖尿病是OMI患者MACEs事件的独立危险因素。sST2联合fQRS预测MACEs的曲线下面积(area under the curve,AUC)为0.791(95%CI:0.723~0.859,P <0.001)。结论 fQRS波可作为评估OMI患者冠脉病变严重程度和协助预警高危患者的一种新型无创指标。fQRS和sST2对OMI患者远期心源性死亡均有较好的预测价值,两者联合应用诊断价值高于单独应用。Objective To investigate characteristics of fragmented QRS(fQRS) in electrocardiogram(ECG) in patients with old myocardial infarction(OMI),and the predictive ability of fQRS combined with soluble suppression of tumorigenicity 2(sST2) in patients with cardiovascular events.Methods Patients with OMI who were hospitalized and underwent coronary angiography from March 2014 to March 2018 were enrolled.The baseline data of patients were collected,and the presence of fQRS wave on admission ECG was recorded.Gensini score was calculated according to the results of coronary angiography and sST2 level was tested.The patients were followed up for 3 years after discharge.The incidence of major adverse cardiovascular events(MACEs) defined as cardiac death was recorded.Logistic regression analysis was used to analyze the risk factors of MACEs in OMI patients.Receiver operating characteristic curve(ROC) was used to analyze the predictive value of fQRS and sST2 alone and in combination for the long-term prognosis of OMI patients.Results A total of 338 patients were enrolled,including 180 patients(53.3%) in the fQRS group and 158(46.7%) in non-FQRS group.Multivariate logistic regression analysis showed that OMI patients with high sST level and Gensini score were more likely to present fQRS.After 3 years of follow-up,45 MACEs were recorded.The results of multivariate logistic regression analysis showed that:performance of fQRS,higher sST2,higher Gensini score and diabetes mellitus history were independent risk factors for MACEs events in OMI patients.The area under the curve(AUC) of sST2 combined with fQRS was 0.791(95%CI 0.723~ 0.859,P<0.001).Conclusions fQRS can be used as a noval noninvasive index to evaluate the severity of coronary artery disease in OMI patients and assist in early warning of high-risk patients.Both fQRS and sST2 have favourable predictive value for long-term MACEs in OMI patients,and the combined application of fQRS and sST2 has higher diagnostic value than single application.

关 键 词：碎裂QRS波 可溶性生长刺激表达基因2蛋白 陈旧性心肌梗死 GENSINI评分 预后 

分 类 号：R542.22[医药卫生—心血管疾病]