健康成年人和肥厚型心肌病患者碎裂QRS波群的分布规律与特征

Distribution and characteristics of fragmented QRS complexes in healthy adults and hypertrophic cardiomyopathy

目的 比较健康成年人和肥厚型心肌病患者碎裂QRS波群（fQRS）的检出率、分布规律与特征.方法 前瞻性连续入选1500名无症状的健康体检者,同时回顾性人选经心脏磁共振检查确诊的肥厚型心肌病患者91例,年龄范围均在18～65岁.记录并分析所有患者的常规12导联心电图.fQRS的定义为至少2个连续导联的QRS波群存在≥2个R波或者R波的波顶或S波的波谷出现顿挫波.结果 健康成人和肥厚型心肌病患者分别有76名（5.1％）和19例（20.9％）检出fQRS（P=0.001）,fQRS平均导联数目无明显差异（2.3±0.7比2.1±0.3,P=0.082）.健康成人中86.8％（66/76）的fQRS分布于下壁导联,另外13.2％（10/76）分布于胸前导联;而肥厚型心肌病患者的fQRS主要分布在下壁导联（10/19,52.6％）,其次分布在前壁导联（6/19,31.8％）及侧壁导联（3/19,15.8％）（与健康成人相比,P＜0.01）.与肥厚型心肌病患者的fQRS相比,健康成人fQRS的平均额面心电轴更偏左[（27.9±30.7）°比（45.5±63.0）°,P=0.024].结论 肥厚型心肌病患者fQRS的检出率高于健康成年人群.与肥厚型心肌病患者的fQRS相比,健康成人的fQRS分布范围更加集中,主要分布于下壁导联,而且额面心电轴更加偏左.

Objective To compare the prevalence, distribution, and characteristics of fragmented QRS complexes （fQRS） in healthy adults and patients with hypertrophic cardiomyopathy. Methods A total of 1500 consecutive asymptomatic subjects who underwent voluntary health examination were prospectively enrolled. In addition, we retrospectively enrolled 91 patients with hypertrophic cardiomyopathy （HCM） diagnosed by cardiac magnetic resonance scanning （all 18-65 years）. The routine 12-lead ECG at rest was documented and analyzed in all subjects, fQRS was defined as presence of ≥2 additional deflections or notching within the QRS complex, including the top of R wave or the nadir of S wave, in at least two continuous leads. Results fQRS was detected in 76 （5.1%） and 19 （20.9%） subjects in healthy adults and HCM, respectively. The mean number of leads displaying fQRS showed no significant difference between the two groups（2.3±0.7 vs 2.1±0.3, P=0.082）. 86.8% （66/76） of fQRS in healthy adults located in the inferior leads and 13.2%（10/76） located in the precordial leads. In contrast, fQRS in patients with HCM predominantly located in the inferior leads （10/19, 52.6% ）, and also located in the precordial leads （6/19, 31.8%） and lateral leads （3/19, 15.8%）（P〈0.001 vs healthy adults）. Compared with HCM patients presenting with fQRS, health adults with fQRS showed greater left deviation of frontal QRS axis [ （27.9±30.7）degree vs （45.5±63.0）degree, P=0.024 ]. Conclusion The prevalence of fQRS was higher in patients with HCM than healthy adults. Compared with fQRS in patients with HCM, the distribution of fQRS in healthy adults was more concentrated, predominantly in inferior leads. Health adults with fQRS showed greater left deviation of frontal QRS axis than HCM patients.