碎裂QRS波对急性心肌梗死患者早期左室重构及心功能的影响

摘要

目的 探讨碎裂QRS波(fQRS)与急性心肌梗死(AMI)患者早期左室重构及心功能的关系.方法 收集我院心脏科监护病房2017年2月—8月确诊为AMI并行经皮冠状动脉介入术(PCI)治疗的患者76例,根据有无fQRS分为fQRS组(29例)和Non-fQRS组(47例),收集患者的临床资料、心电图、实验室检查指标、冠脉造影结果、实时三维彩色超声指标,分析fQRS与基线资料、三维彩色超声结果的关系,同时探讨影响左室重构及心功能的因素.结果 与Non-fQRS组相比,fQRS组左室舒张末容积(LVEDV)、左室收缩末容积(LVESV)更大,左室射血分数(LVEF)更小,差异有统计学意义(P<0.05);fQRS组Tmsv 16-SD(%)、Tmsv 16-Dif(%)测值均较Non-fQRS组明显增加,差异有统计学意义(P<0.05);2组间Tmsv 16-SD(ms)、Tmsv 12-SD(ms)、Tmsv 12-SD(%)、Tmsv 6-SD(ms)、Tmsv 6-SD(%)、Tmsv 16-Dif(ms)、Tmsv 12-Dif(ms)、Tmsv 12-Dif(%)、Tmsv 6-Dif(ms)、Tmsv 6-Dif(%)比较差异无统计学意义;Logistic回归分析显示fQRS、Gensini评分均对心功能有影响,fQRS是左室重构的独立危险因素.结论 AMI合并fQRS患者的早期左室重构更明显,fQRS可较好地预测左室重构.%Objective To investigate the relationship between fragmented QRS (fQRS) complex and the early left ventricular remodeling or heart function in patients with acute myocardial infarction(AMI).Methods A total of 76 patients with AMI hospitalized in CCU of the Second Hospital of Tianjin Medical University were enrolled in the study.Patients were divided into fQRS group (n=29) and non-fQRS group (n=47). The clinical data including ECG, laboratory indicators, coronary angiography results and real-time three-dimensional (RT-3D) echocardiography parameter were collected in two groups.The relationship between fQRS and baseline data,fQRS and RT-3D echocardiography parameter were analyzed.At the same time,the influencing factors of left ventricular remodeling and heart function were discussed in the study. Results Compared with non-fQRS group, left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV)were significantly higher,and left ventricular ejection fraction(LVEF)was significantly lower in fQRS group(P<0.05).Several three-dimensional parameters including Tmsv16-SD(%)and Tmsv 16-Dif(%)were significantly higher in fQRS group than those in non-fQRS group(P<0.05).There were no significant differences in Tmsv 16-SD(ms),Tmsv 12-SD(ms),Tmsv 12-SD(%),Tmsv 6-SD(ms),Tmsv 6-SD(%),Tmsv 16-Dif(ms),Tmsv 12-Dif(ms),Tmsv 12-Dif(%),Tmsv 6-Dif(ms)and Tmsv 6-Dif(%)between two groups.Logistic regression analysis showed that fQRS and Gensini scores had effects on heart function.At the same time,fQRS was an independent predictor for left ventricular remodeling. Conclusion Left ventricular remodeling is more obvious in patients with acute myocardial infarction complicated with fQRS,and fQRS can predict left ventricular remodeling better.