碎裂QRS波对心脏再同步治疗无反应的预测价值

Predictive value of fragmented QRS on nonresponse to cardiac resynchronization therapy

目的探讨碎裂QRS波(f QRS)对心脏再同步治疗(CRT)无反应的预测价值。方法选择150例患者,按心电图是否有f QRS分为f QRS组和无f QRS组。CRT术前及术后6个月行纽约心功能分级,心电图和超声心动图检查。以术后6个月时心功能分级改善Ⅰ级以上或左室射血分数(LVEF)增加≥5%作为CRT有反应的标准,未达到该标准或患者心源性死亡定义为CRT无反应。用单因素和多因素Logistic回归分析f QRS对CRT无反应的预测价值。结果1 f QRS组较无f QRS组CRT无反应发生率高(52.6%vs18.7%,P<0.01)。2单因素及多因素Logistic回归分析均提示f QRS是CRT无反应的独立危险因素。结论 f QRS对CRT无反应有一定的预测价值。

Objective To explore the value of fragmented QRS（ fQRS） in predicting the incidence of nonresponse to cardiac resynchronization therapy（ CRT） . Methods One hundred and fifty patients were enrolled in this study. Study populations were divided into fQRS group and non-fQRS group according to the existence of fQRS on electro-cardiography （ ECG） . Before CRT implantation as well as 6 months after implantation,New York Heart Association （ NYHA） class, ECG and echocardiography were evaluated. Response to CRT was defined as improvement of at least one NYHA class or improvement of left ventricular ejection fraction （ LVEF） ≥5% 6 months after implana-tion. Patients were defined as nonresponders if they did not reach the prespecified standard or died of cardiac cau-ses. The univariate and multivariate Logistic regression analysis was performed to evaluate the predictive value of fQRS on nonresponse to CRT. Results ①Patients in fQRS group had a higher chance of nonresponse to CRT than in non-fQRS group （52. 6% vs 18. 7% P〈0. 01）. ②Both univariate and multivariate Logistic regression analysis showed that fQRS was an independent predictor of nonresponse to CRT. Conclusion fQRS is valuable in predic-ting the incidence of nonresponse to CRT.