背景:QRS片段(fQRS)代表局部心肌纤维化的标志物,尤其是冠心病(冠心病)患者。然而,关于fQRS与Gensini评分定义的冠状动脉粥样硬化严重程度之间的相关性知之甚少.
目的:根据fQRS的位置和范围,确定疑似CAD患者的血管造影和超声心动图特征。
方法:共178例接受冠状动脉造影的患者被纳入研究。fQRS定义为存在RSR'和/或R/S波的陷波(如果QRS<120ms)或R/S波的≥2个陷波(如果QRS≥120ms)。所有患者分为三组:非fQRS;1-2和≥3导联的fQRS。
结果:LVEF(左心室射血分数,P=0.009)和冠状动脉粥样硬化严重程度(P=0.008)。非fQRS组(轻度CAD)的中位数Gensini评分为7,其他组(重度CAD)的中位数为20。与无fQRS相比,前fQRS组和外侧fQRS组的LVEF均较低(分别为P=0.039和P=0.01)。在外侧fQRS的情况下,中位数Gensini评分明显更高(P=0.037)。≥1导联的fQRS与冠状动脉闭塞相关(OR2.1,95%CI:1.1-4.1,P=0.038)。
结论:fQRS的存在,特别是在横向引线中,能够是严重冠状动脉粥样硬化的有用非侵入性标志物。≥1个碎裂导线的患者LVEF较低,Gensini评分较高,闭塞风险增加2倍.
BACKGROUND: QRS fragmentation (fQRS) represents a marker of local myocardial fibrosis, especially in patients with CAD (coronary artery disease). However, little is known about the association between fQRS and the severity of coronary atherosclerosis as defined by the Gensini score.
OBJECTIVE: To identify the angiographic and echocardiographic characteristics of patients with suspected CAD depending on the location and extent of fQRS.
METHODS: A total of 178 patients who underwent coronary angiography were included in the study. fQRS was defined as the presence of RSR\' and/or notching of the R/S wave (if QRS<120ms) or≥2 notches of the R/S wave (if QRS≥120ms). All patients were divided into three groups: non-fQRS; fQRS in 1-2 and≥3 leads.
RESULTS: Statistically significant differences in the LVEF (left ventricular ejection fraction, P=0.009) and the degree of coronary atherosclerosis severity (P=0.008) were found among 3 groups. The median Gensini score was 7 in non-fQRS group (minimal CAD) and >20 in other groups (severe CAD). Both the anterior and lateral fQRS groups had a lower LVEF compared to no fQRS (P=0.039 and P=0.01, respectively). The median Gensini score was significantly higher in case of the lateral fQRS (P=0.037). fQRS in≥1 lead was associated with coronary occlusion (OR 2.1, 95% CI: 1.1-4.1, P=0.038).
CONCLUSIONS: The presence of fQRS, particularly in lateral leads, can be a useful noninvasive marker of severe coronary atherosclerosis. Patients with≥1 fragmented lead have a lower LVEF, a higher Gensini score and a two-fold increased risk of occlusion.