碎裂QRS波对急性ST段抬高型心肌梗死患者左心室收缩功能的影响

The Effect of Fragmented QRS Complex on the Left Ventricular Systolic Function in Patients with Acute ST-segment Elevation Myocardial Infarction

目的探讨急性ST段抬高型心肌梗死(STEMI)患者碎裂QRS波(fQRS)与心功能的关系。方法回顾性分析郑州大学第二附属医院心内科2016年9月至2019年5月住院治疗的212例确诊为STEMI的患者,其中心电图合并有fQRS的85例,无fQRS的127例,记录212例患者的性别、年龄、体重指数(BMI)、高血压病史、吸烟史、糖尿病史、心肌标志物、心肌酶、血脂、血糖、肌酐等一般临床资料,所有入选患者已行心脏彩色多普勒超声及冠脉造影检查,同时记录左室射血分数(LVEF)及冠脉造影结果,并计算Gensini评分,应用Logistic回归分析f QRS对左心室收缩功能的影响。结果左室收缩功能正常组与左室收缩功能不全组在TC、fQRS波、Gensimi评分之间的差异有统计学意义(P<0.01),Logistic回归分析显示fQRS(OR=3.686,95%CI:2.011~6.755)、Gensini评分(OR=1.011,95%CI:1.000~1.023)是左室收缩功能不全的影响因素。结论急性ST段抬高型心肌梗死合并fQRS患者的左室收缩功能更差,fQRS可较好地预测左室收缩功能不全。

Objective To explore the relationship between fragmented QRS complex(fQRS)and heart function in patients with acute st-segment elevation myocardial infarction(STEMI).Methods A retrospective analysis was conducted on 212 patients diagnosed as STEMI admitted to the department of cardiology of the second affiliated hospital of zhengzhou university from September 2016 to May 2019.Among them,85 cases had combined ecg with fQRS and 127 cases without fQRS.General clinical data including gender,age,body mass index(BMI),history of hypertension,smoking history,diabetes history,myocardial markers,myocardial enzymes,blood lipids,blood glucose and creatinine were recorded.All the patients have coronary angiography and cardiac color doppler ultrasound examination,at the same time record at the end of the left ventricular ejection fraction(LVEF)and the result of coronary angiography,and calculate the Gensini score,Logistic regression was used to analyze the effects of fQRS on left ventricular systolic function.Results There were statistically significant differences in TC,fQRS,Gensini score between the normal left ventricular systolic function group and the left ventricular systolic dysfunction group(P<0.01).Logistic regression analysis showed that fQRS(OR=3.686,95%ci:2.011-6.755),Gensini score(OR=1.011,95%ci:1.000-1.023)were the influencing factors of left ventricular systolic dysfunction.Conclusion Patients with acute st-segment elevation myocardial infarction combined with fQRS had worse left ventricular systolic function,and fQRS could better predict left ventricular systolic dysfunction.