无陈旧性心肌梗死病史的冠状动脉慢性完全闭塞患者侧支循环与碎裂QRS波的关系

The relationship between fragmented QRS complex and coronary collateral circulation in patients with chronic total occlusion lesion without prior myocardial infarction

目的探讨无陈旧性心肌梗死病史的冠状动脉慢性完全闭塞（CTO）患者冠状动脉侧支循环（CCC）与心电图碎裂QRS波的关系。方法回顾性分析2014年5月至2015年10月在南京医科大学附属南京医院连续纳入的无陈旧性心肌梗死病史的单支冠状动脉CTO病变患者238例。按照Rentrop分级法评估CCC，将患者分为CCC不良组（0和1级，58例）和CCC良好组（2和3级，180例）。碎裂QRS波定义为至少两个连续导联的QRS波存在≥2个R波或R波的波顶或S波的波谷出现顿挫波。采用多因素logistic回归分析CCC与心电图碎裂QRS波的关系。结果CCC不良组与CCC良好组的年龄[（65.2±8.9）岁比（60.3±10.1）岁，P＝0.03]、空腹血糖水平[（7.22±3.00） mmol/L比（6.31±1.83）mmol/L，P＝0.04]和左心室射血分数[（45.2±11.4）%比（51.2±13.5）%，P＝0.02]差异均有统计学意义。CCC分级为0级的患者为0例，CCC 1、2和3级患者心电图存在碎裂QRS波的比例分别为69.0%（40/58）、48.6%（35/72）和19.4%（21/108），差异有统计学意义（P〈0.01）。CCC不良组患者心电图存在碎裂QRS波的比例高于CCC良好组[69.0%（40/58）比31.1%（56/180），P〈0.01]，碎裂QRS波导联数也多于CCC良好组[3（0，4）个比0（0，3）个，P〈0.01]。多因素logistic回归分析显示，无陈旧性心肌梗死病史的冠状动脉CTO患者CCC形成不良与心电图碎裂QRS波独立相关（OR＝3.659，95%CI 1.619～8.217，P〈0.01）。结论无陈旧性心肌梗死病史的冠状动脉CTO患者的CCC形成不良与心电图碎裂QRS波独立相关。

ObjectiveTo explore the relationship between fragmented QRS complex（fQRS） and coronary collateral circulation（CCC） in patients with chronic total occlusion（CTO）lesion without prior myocardial infarction.MethodsThis retrospective study analyzed 238 consecutive patients with CTO lesion in one of the major coronary arteries from May 2014 to October 2015 in our department. Patients were divided into poor CCC group （grade 0 and 1, 58 cases） and good CCC group（grade 2 and 3, 180 cases） based on Rentrop′s classification of CCC. The fQRS was defined as the presence of an additional R wave or notching of R or S wave or the presence of fragmentation in two contiguous electrocardiogram leads corresponding to a major coronary artery territory. Multivariate logistic regression was used to analyze the relationship between CCC and fQRS on electrocardiogram.ResultsCompared with good CCC group, patients in poor CCC group had older age（（65.2±8.9）years old vs. （60.3±10.1） years old, P=0.03）, higher plasma glucose （（7.22±3.00） mmol/L vs.（6.31±1.83）mmol/L, P=0.04）, and lower left ventricular ejection fraction （（45.2±11.4）% vs. （51.2±13.5）%, P=0.02）. None of patients had Rentrop grade 0, the presence of fQRS on ECG in patients with Rentrop grade 1, grade 2, and grade 3 CCC was 69.0% （40/58）, 48.6% （35/72） , and 19.4% （21/108）, respectively （P〈0.01）. The presence of fQRS were higher in poor CCC group than in good CCC group （69.0%（40/58）vs. 31.1%（56/180）, P〈0.01）, and number of leads with fQRS were higher in poor CCC group than in good CCC group （3（0, 4）vs.0（0, 3）, P〈0.01）. Multivariate logistic regression analysis demonstrated that poor CCC growth in patients with CTO lesion without prior myocardial infarction was independently related to the presence of fQRS （OR=3.659, 95%CI 1.619-8.217, P〈0.01）.ConclusionPoor CCC in patients with CTO lesion without prior myocardial infarction is independently related to the presence of fQRS on electrocardiogram.