急性心肌梗死心电图fQRS波与冠脉病变范围及程度的相关性分析

Correlation Analysis of Electrocardiogram fQRS Wave With the Extent and Degree of Coronary Lesions in Acute Myocardial Infarction

目的探讨急性心肌梗死(acute myocardial infarction,AMI)患者心电图碎裂QRS波(fragmented QRS complex,fQRS)波与冠脉病变范围及程度的相关性。方法选取2023年1—12月黔东南苗族侗族自治州人民医院收治的80例AMI患者,根据心电图有无fQRS波分为非fQRS组(n=48)与fQRS组(n=32)。分析2组患者一般资料,采用超声检查技术对患者的心脏功能进行评估,并基于超声检查获取的患者左室射血分数(left ventricular ejection fraction,LVEF)和左心室舒张末期直径(left ventricular end-diastolic diamete,LVEDd)的相关数据。利用冠脉造影评估患者冠脉病变范围、狭窄程度及病变血管,并比较冠脉造影Gensini评分,采用Spearman相关系数分析fQRS波与冠脉病变范围和严重程度之间的相关性。利用多变量Cox比例风险回归模型(Cox proportional-hazards model,Cox)对AMI患者进行分析,以识别可能导致不良心血管事件的危险因素。结果fQRS组高血压、糖尿病、不良心血管事件发生率、LVEDd均高于非fQRS组,LVEF低于非fQRS组(P<0.05)。fQRS组在冠脉病变范围、狭窄程度和Gensini评分方面高于非fQRS组(P<0.05)。Pearson相关性分析显示,fQRS波与高血压、糖尿病、不良心血管事件、LVEDd、冠脉病变范围(双多支病变)、狭窄程度(中重度狭窄)以及Gensini评分等呈正相关(r=0.233、0.310、0.275、0.559、0.345、0.386、0.660,P<0.05);fQRS波与LVEF呈负相关(r=-0.634,P<0.001)。采用Cox对AMI患者进行分析显示,高血压、糖尿病、LVEDd、病变范围(双多支病变)、狭窄程度(中重度狭窄)、fQRS波以及Gensini评分均是AMI患者发生心血管不良事件的危险因素(P<0.05)。而LVEF则被认为是该患者群体的保护因素(P<0.05)。其中,fQRS波作为独立预测因子的风险比(hazard ratio,HR)为2.695(95%CI 1.487~3.857)。结论fQRS波在AMI患者中较为常见,其与冠脉病变的广泛性和严重性有关,这一因素被认为是预测不良心血管事件方面具有显著的独立性,在临床应用中具有重要价值,可协助医务人员制定更有效的预治策略,改善患者预后。

Objective To explore the correlation between fragmented QRS complex(fQRS)wave on electrocardiogram and the range and degree of coronary artery disease in patients with acute myocardial infarction(AMI).Methods A total of 80 AMI patients admitted to Qiandongnan Miao and Dong Autonomous Prefecture People's Hospital from January to December 2023 were selected.They were divided into non fQRS group(n=48)and fQRS group(n=32)based on the presence or absence of fQRS waves on the electrocardiogram.General information of the two groups of patients was analyzed,and left ventricular ejection fraction(LVEF)and left ventricular end-diastolic diamete(LVEDd)levels were collected by ultrasound examination.Coronary angiography was used to evaluate the number of coronary lesion range,stenosis degre,and diseased vessel in the patients,the Gensini score of coronary angiography was detected and compared,and the Spearman correlation coefficient was used to analyze the correlation between fQRS wave and the extent and severity of coronary artery disease.For patients with AMI,a multivariable Cox proportional hazards model(Cox)was used to identify risk factors associated with adverse cardiovascular events.Results The incidence of hypertension,diabetes,adverse cardiovascular events and LVEDd in fQRS group were higher than those in non FQRS group,and LVEF was lower than that in non FQRS group(P<0.05).fQRS group had higher coronary lesion range,stenosis degree and Gensini score than non FQRS group(P<0.05).Pearson correlation analysis showed that fQRS waves were positively correlated with hypertension,diabetes,adverse cardiovascular events,LVEDd,coronary lesion range(double and multiple vessel lesions),stenosis degree(moderate to severe stenosis)and Gensini score(r=0.233,0.310,0.275,0.559,0.345,0.386,0.660,P<0.05),fQRS waves were negatively correlated with LVEF(r=-0.634,P<0.001).Cox analysis of AMI patients showed that hypertension,diabetes,LVEDd,lesion scope(double and multiple vessel lesions),stenosis degree(moderate to severe stenosis),fQRS wave and Gensini score were all risk factors for cardiovascular adverse events in AMI patients(P<0.05).LVEF was considered a protective factor in this patient population(P<0.05).The hazard ratio(HR)of fQRS as an independent predictor was 2.695(95%CI 1.487 to 3.857).Conclusion fQRS waves are common in AMI patients and are related to the extent and severity of coronary artery lesions.This factor is considered to be significantly independent in predicting adverse cardiovascular events,and has important value in clinical application,which can assist medical personnel to develop more effective pre-treatment strategies and improve patient prognosis.