碎裂QRS波在发绀型先天性心脏病患者风险分层中的作用

Role of fragmentation QRS for risk stratification in patients with cyanotic congenital heart disease

目的:统计发绀型先天性心脏病(CCHD)患者心电图上碎裂QRS波(fQRS)的患病率,并评估fQRS对CCHD患者的预后价值。方法:我们回顾性分析了2017年1月至2019年12月在北京安贞医院接受根治性手术的147例CCHD患者的临床资料。根据术前心电图是否检出fQRS分为fQRS检出组和非fQRS检出组。使用单变量和多变量逻辑回归分析评估fQRS与患者术后心血管不良事件之间的关系。结果:本研究共纳入符合入选标准的CCHD患者147例,其中男性64例(44%),年龄84(11,708)个月。共有38例患者(26%)发生心血管不良事件,其中7例患者(4.8%)死亡。fQRS存在于63例(43%)。fQRS导联数(OR=1.476,95%CI:1.173-1.859)以及住院时间(OR=1.196,95%CI:1.103-1.297)是患者发生心血管不良事件的危险因素(P<0.05)。fQRS导联数对预测患者发生不良心血管事件的ROC曲线下面积为77.8%(95%CI:0.688-0.869)。结论:与心肌纤维化相关的其他疾病一样,fQRS也可以预测CCHD患者根治性手术后的不良心血管结局。

Objective:To investigate the prevalence of fragmented QRS(fQRS)on electrocardiograms in patients with cyanotic congenital heart disease(CCHD)and to evaluate the prognostic value of fQRS in CCHD patients.Methods:We retrospectively analyzed the clinical data of 147 patients with CCHD undergoing radical operation in Beijing Anzhen Hospital between January 2017 and December 2019.According to whether fQRS was detected in preoperative ECG,they were divided into fQRS detection group and non-fQRS detection group.The relationship between fQRS and patients'adverse cardiovascular events after surgery was evaluated using univariate and multivariate logistic regression analyses.Results:A total of 147 CCHD patients were included in this study,of which 64 were male(44%),aged 84(11,708)months.A total of 38 patients(26%)had cardiovascular adverse events,of which 7 patients(4.8%)died.fQRS was present in 63 patients(43%).The presence of fQRS(OR=1.476,95%CI:1.173-1.859)and hospital stay time(OR=1.196,95%CI:1.1031.297)were independent risk factors for adverse cardiovascular events in patients(P<0.05).The area under the ROC curve for the number of fQRS leads to predict adverse cardiovascular events in patients was 77.8%(95%CI:0.688-0.869).Conclusions:Like in the case of the other diseases associated with myocardial fibro-sis,fQRS could also predict poor cardiovascular outcomes in CCHD patients after radical operation.