冠心病患者运动平板试验中碎裂QRS波特点及其与室性心律失常的相关性  

Characteristics of Fragmented QRS Waves and Their Correlations with Ventricular Arrhythmias in Patients with CHD During Treadmill Exercise Test

作　　者：凌静 吴瑶 田国平 Ling Jing;Wu Yao;Tian Guoping(Department of Functional Examination,the Second Affiliated Hospital of University of South China,Hengyang 421001,China;Department of Cardiovascular Medicine,the Second Affiliated Hospital of University of South China,Hengyang 421001,China)

机构地区：[1]南华大学附属第二医院功能检查科,衡阳421001 [2]南华大学附属第二医院心血管内科,衡阳421001

出　　处：《华中科技大学学报（医学版）》2024年第5期659-669,共11页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：2021年度湖南省自然科学基金资助项目(No.2021JJ3060608)。

摘　　要：目的 探讨冠心病患者运动平板试验中碎裂QRS波特点及其与室性心律失常的相关性。方法 选取南华大学附属第二医院2021年11月至2022年10月收治的疑似冠心病或临床确诊冠心病患者216例为研究对象。收集受试者的一般临床资料、心脏超声指标、实验室指标、心电参数。通过冠状动脉造影术将纳入患者分为冠心病组(n=152)和非冠心病组(n=64)。依据平板运动试验中是否出现碎裂QRS(fQRS)波,将冠心病组和非冠心病组又分别分为QRS组(未出现fQRS波)和fQRS组(出现fQRS波)。对于确诊的冠心病患者,观察其12个月内室性心律失常事件发生情况,并据此将冠心病组分为室性心律失常组(n=80)和非室性心律失常组(n=72)。使用ROC曲线分析运动平板试验中fQRS波对冠心病的诊断效能。Logistic回归调整混杂因素,探讨fQRS波时限与冠心病患者发生室性心律失常风险的关系。使用随机森林算法对室性心律失常可能的影响因素进行筛选,并依据回归方程y=1-1/(1+e^(-x)),得到室性心律失常事件的预测公式。Bootstrap法验证预测模型。结果 冠心病组的运动平板试验中fQRS波发生率(116/152,76.32%)明显高于非冠心病组(21/64,32.81%),差异有统计学意义(P<0.05)。运动平板试验中fQRS波对冠心病检验的ROC曲线下面积(AUC)最大为0.899(P<0.05),灵敏度、特异度分别为94.3%、78.2%,约登指数为0.725。在冠心病组中,与运动前比较,运动后QRS波和fQRS波时限均明显延长(均P<0.05),且fQRS波运动前后时限变化明显比QRS波长(P<0.05)。在152例冠心病患者中,与QRS波比较,fQRS波的双支及多支病变的病例占比明显较高,重度狭窄及完全闭塞的病例占比明显较高,差异有统计学意义(均P<0.05);fQRS波的Gensini评分明显高于QRS波,差异有统计学意义(P<0.05)。运动平板试验中,运动前和运动后的fQRS波时限与Gensini评分呈明显正相关。在冠心病组中,fQRS组室性心�Objective To investigate the characteristics of fragmented QRS waves and their correlation with ventricular arrhythmias in coronary heart disease patients during treadmill exercise tests.Methods A total of 216 patients suspected of having coronary heart disease or clinically diagnosed at our hospital from November 2021 to October 2022 were selected for the study.The general clinical data,cardiac ultrasound indices,laboratory indices and ECG parameters of the subjects were collected.The patients were divided into two groups according to the results of coronary angiography:coronary heart disease(CHD)group(n= 152)and non-CHD group(n= 64).According to the presence of the fQRS wave in the treadmill exercise test,the CHD group and non-CHD group were divided into the QRS group(without the fQRS wave)and the fQRS group(with the fQRS wave).For patients with confirmed CHD,the occurrence of ventricular arrhythmia within 12 months was observed,and the CHD group was divided into a ventricular arrhythmia group(n= 80)and non-ventricular arrhythmia group(n= 72).ROC curves were used to analyze the diagnostic efficacy of the fQRS wave in the exercise treadmill test for CHD.A logistic regression model adjusted for confounding variables was used to explore the relationship between fQRS wave duration and the risk of ventricular arrhythmias in patients with CHD.Random forest algorithm was used to screen the possible influencing factors of ventricular arrhythmias,and the formula for predicting ventricular arrhythmia events was obtained according to the regression equation y=1-1/(1+e^(-x)).Bootstrap method was used to verify the prediction model.Results In the exercise treadmill test,the incidence of fQRS wave in the CHD group(116/152,76.32%)was significantly higher than that in the non-CHD group(21/64,32.81%).In the exercise treadmill test,the maximum area under the ROC curve(AUC)of the fQRS wave for CHD was 0.899(P<0.05),the sensitivity and specificity were 94.3% and 78.2%,respectively,and the Youden index was 0.725.In the CHD group,th

关 键 词：冠心病 fQRS波 fQRS波时限 室性心律失常 

分 类 号：R541.4[医药卫生—心血管疾病]