肥厚型心肌病心电图碎裂QRS波与磁共振扫描心肌延迟增强相关性分析

Association between fragmented QRS on electrocardiogram and late gadolinium-enhanced cardiac magnetic resonance in patients with hypertrophic cardiomyopathy

目的探讨肥厚型心肌病(hypertrophic cardiomyopathy,HCM)患者心电图出现碎裂QRS波(fragmented QRS,fQRS)与心脏磁共振扫描(cardiac magnetic resonance,CMR)心肌延迟增强的相关性。方法 HCM患者141例,均行CMR及心电图检查,记录患者一般情况、家族史、超声心动图指标、心电图指标、CMR是否检出心肌延迟增强及部位,分析心电图fQRS与CMR检出心肌延迟增强的相关性。结果 141例心电图出现病理性Q波9例(6.4%),余132例心电图出现fQRS者52例(fQRS组)、未出现fQRS者80例(无fQRS组);fQRS组最大室壁厚度、E/A比值及HCM家族史、家族猝死史、伴束支阻滞、CMR检出心肌延迟增强比例与无fQRS组比较差异均有统计学意义(P<0.05);HCM家族史、心电图伴束支传导阻滞及CMR检出心肌延迟增强是HCM患者心电图出现fQRS的独立危险因素。结论HCM患者心电图fQRS与CMR检出心肌延迟增强相关,HCM患者心电图出现fQRS可能与早期心肌纤维化有关。

Objective To explore the association between fragmented QRS （fQRS） on 12-lead electrocardiogram （ECG） and late gadolinium-enhanced cardiac magnetic resonance （LGE-CMR） in patients with hypertrophic cardiomyopathy （HCM）. Methods A total of 141 HCM patients underwent both CMR and ECG. The general conditions, family history, the parameters of echocardiography and ECG, and the detected CMR-LGE and LGE location were recorded to analyze the correlation between fQRS on ECG and detected CMR-LGE. Results Pathological Q wave was found in 9 patients （6.4%）. In the other 132 patients, 52 patients were found fQRS （fQRS group） and 80 patients were not found no fQRS （non-fQRS group）. There were significant differences in maximal rentricular wall thickness, E/A ratio, familial history of HCM, familial sudden death, branch bundle block and detection rate of CMR-LGE between fQRS and non-fQRS groups （P〈0. 05）. The familial history of HCM, branch bundle block and CMR-LGE were independent risk factors for fQRS on ECG in HCM patients. Conclusions fQRS on ECG is correlated with CMR-LGE in HCM patients, and might be involved in early myocardial fibrosis.