fQRS波预测陈旧性心肌梗死患者室性心律失常的价值

Value of fQRS in predicting ventricular arrhythmia of patients with old myocardial infarction

目的探讨fQRS对陈旧性心肌梗死(OMI)患者室性心律失常的预测价值。方法 235例OMI患者进行心电图检查,根据QRS心电图特征,分为病理性Q波(A组)、OMI伴碎裂QRS波(fQRS)(B组)、OMI伴病理性Q波和fQRS(C组),对所有病例进行动态心电图检查,对三组的室性心律失常结果对比分析。结果 A、B、C组室性心律失常的发生率分别为69.1%、74.4%、71.7%,三组比较无显著性差异;两种或两种以上室性心律失常的发生率分别为20.6%(14/68)、40.5%(49/121)、43.5%(20/46),B、C组与A组比较P均<0.05。A组室早总数≥720个/24 h、成对室早、室早Lown分级3～5级发生率明显少于B组、C组;A组多源性室早发生率明显少于B组(P均<0.05)。结论 fQRS与室性心律失常的发生密切相关;fQRS是OMI心脏事件的独立预测因素。

Objective To investigate the predictive value of fQRS for ventricular arrhythmias occurrence in patients with old myocardial infarction （OMI）. Methods Selected 235 patients with OMI for ECG examination, then divided them into pathologic Q waves group （Group A）, OMI with fragmented QRS complex （fQRS） （Group B）, OMI with both patho- logical Q wave and fQRS （Group C）, according to QRS ECG characteristics. Then all the cases were examined by dynamic ECG, and comparative analysis was made for the ventricular arrhythmias occurrence of three groups. Results Occurrence of ventricular arrhythmia in Group A, B and C was respectively 69.1% （47/68）, 74.4% （90/121）, and 71.7 % （33/ 46）, thus differences between three groups were not significant; occurrence of two or more ventricular arrhythmia was 20.6% （ 14/68）, 40.5% （49/121）, 43.5% （20/46）, which in Group C and B were both significantly higher than that in group A （ both P 〈 0.05）. The incidence of PVCs 〉 720 / 24 h, grade 3 to 5 ventricular contraction as Lown classification in Group C and B were both significantly higher than those in Group A （P 〈 0.05） ; the incidence of polymorphic PVCs in Group A was significantly lower than that in Group B （P 〈 0.05 ）. Conclusions fQRS is closely related with ventricular arrhythmia occurrence; fQRS is a predictive factor to independent cardiac events for OMI patients.