碎裂QRS波与肥厚型心肌病患者心肌纤维化／瘢痕的关系

Relationship between fragmented QRS complexes on the routine electrocardiogram and myocardial fi- brosis/scar in patients with hypertrophic cardiomyopathy

目的评价常规12导联心电图检出的碎裂QRS波（fragmentedQRScomplex，fQRS）与肥厚型心肌病患者心肌纤维化／瘢痕的关系。方法91例肥厚型心肌病患者，通过心脏磁共振检查检出心肌纤维似瘢痕。记录所有患者的常规12导联心电图，判读是否存在fQRS。结果91例患者中，58例（63．7％）经由心脏磁共振检出了延迟增强（1ategadoliniumenhancement，LGE），其中19例（20．9％）心电图检出fQRS。LGE阳性患者的fQ—RS检出率显著高于LGE阴性患者（31．0％对3．0％，P=0．002）。在检出fQRs的19例患者中，18例（94．7％）检出了LGE。在检出LGE的患者中，fQRs阳性患者较fQRS阴性患者的LGE节段分布更为广泛（2．8±1．6对2．0±1．1，P=0．035）。fQRS在肥厚型心肌病患者中检出心肌纤维化／瘢痕的敏感性和特异性分别为31．0％和97．0％。结论常规12导联心电图上检出的fQRs是肥厚型心肌病患者存在心肌纤维4L／瘢痕的特异性指标，但其敏感性有限。

Objective This study aimed to investigate the relationship between the fragmented QRS complexes （fQRS） on routine 12-lead electrocardiograms （ECG） and the myocardial fibrosis/scar detected by late gadolinium enhancement-cardiac magnetic resonance（LGE-CMR） in patients with hypertrophic cardiomyopathy （HCM）. Methods Patients with HCM,in whom the presence and distribution of myocardial fibrosis/scar in the left ventricle were evaluated by LGE-CMR, were included, fQRS was defined as the presence of t〉 1 addi- tional R waves （ R＇ ） or notching in the peak of the R wave or the nadir of the S wave in at least two contiguous leads of the routine 12-lead ECG. Results Of 91 patients,58（63. 7% ）showed LGE distributed in the left ven- tricle, while only 19 （20. 9% ）presented fQRS. The incidence of fQRS in the LGE-positive group was significant- ly higher than that in the LGE-negative group（31.0% vs 3.0% ,P=0. 002）. Notably ,LGE was detected in all but one patients displaying fQRS. The sensitivity and specificity of fQRS in detecting myocardial fibrosis/scar in patients with HCM were 31.0% and 97.0% ,respectively. Conclusion fQRS on routine 12-lead ECG seems to be a specific marker of myocardial fibrosis/scar in patients with HCM ,but with limited sensitivity.