目的 探讨心电图碎裂QRS波(fQRS)与心功能接近正常的冠状动脉粥样硬化性心脏病(以下简称冠心病)患者左室同步性的关系.方法 选取左室收缩功能接近正常和心电图窄QRS波的冠心病患者176例,根据其心电图有无fQRS分为fQRS阳性组55例和fQRS阴性组121例.应用组织多普勒技术测量左室各节段的收缩速度、速度达峰时间,并计算12节段速度达峰时间最大差值(Ts-12)及标准差(Ts-SD),比较两组上述各参数的差异;并以Ts-SD≥32.6 ms作为左室不同步标准,对fQRS与临床、超声心动图各参数之间的关系行多因素Logistic回归分析.结果 fQRS阳性组的Ts-12、Ts-SD较fQRS阴性组明显延长[(128.8±49.6)ms vs.(110.6±46.3)ms,(43.7±17.7)ms vs.(37.8±17.4)ms],差异均有统计学意义(P=0.019、0.040).且fQRS阳性组发生左室收缩不同步的比例明显高于fQRS阴性组(75%vs.58%),差异有统计学意义(P=0.033).fQRS是预测左室不同步指数Ts-SD和多支冠状动脉病变的相关因素(OR=1.06、2.85,P=0.016、0.011).结论 窄QRS波、心功能接近正常的fQRS阳性冠心病患者存在明显左室收缩不同步.%Objective To investigate the relationship between fragmented QRS(fQRS)and left ventricular systolic synchronicity in patients with coronary heart disease (CHD). Methods A total of 176 CHD patients with narrow QRS and near-normal EF were recruited and divided into two groups according to the ECG with or without fQRS,fQRS group(n=55) and non-fQRS group (n=121).The systolic velocity of left ventricular segments, time to peak were evaluated by tissue Doppler imaging echocardiography.The maximum and standard values(Ts-12, Ts-SD) of the time to peak in twelve segments were calculated.The differences in the two groups were compared and Ts-SD≥32.6 ms was used as the standard of intraventricular dyssynchrony.The association between fQRS and clinical and echocardiographic variables was analyzed using multivariable Logistic regression models.Results The Ts-12 and Ts-SD were significantly prolonged in fQRS group compared with non-fQRS group[(128.8± 49.6)ms vs.(110.6±46.3)ms,(43.7±17.7)ms vs. (37.8±17.4)ms,P=0.019,0.040].In addition,the proportion of left ventricular dyssynchrony was significantly higher in patients with fQRS compared with those without fQRS(75% vs . 58%, P=0 . 033). Multivariate analysis revealed that Ts-SD(OR=1.06,P=0.016) and multivessel lesion(OR=2.85,P=0.011) were independent predictors for fQRS. Conclusion Intraventricular dyssynchrony is evident in CHD patients with narrow QRS and fQRS.
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