BACKGROUND: QRS fragmentation (fQRS) has been shown to be a marker of scar in patients with left ventricular dysfunction. Whether fQRS is associated with progressive left ventricular remodeling and increased mortality in patients receiving cardiac resynchronization therapy (CRT) is unclear. METHODS: We reviewed the preimplant and follow-up echocardiograms in 233 patients undergoing the new implantation of a CRT device between December 2001 and November 2006. Patients were included if they had a pre-CRT ECG with appropriate filter settings (filter 0.16-100 or 0.16-150 Hz, 25 mm/s, 10 mm/mV), a left ventricular ejection fraction (LVEF) =40%, and New York Heart Association class II-IV symptoms on standard medical therapy. The 12-lead electrocardiogram (ECG) was interpreted by two blinded reviewers for the presence of fQRS. Remodeling end points, including changes in LVEF and left ventricular end-diastolic (LVEDV) and systolic (LVESV) volumes, were compared between patients with and without contiguous fQRS, and an assessment of all-cause mortality was made. RESULTS: Two hundred thirty-two patients met inclusion criteria, of which 50 demonstrated fQRS in contiguous leads. There was no difference in improvement in LVEF (%) (7.9 +/- 12.9 vs 6.8 +/- 11.0, P = 0.60) or reduction in LVEDV (mL) (-30.1 +/- 57.2 vs -15.7 +/- 47.6) or LVESV (mL) (-33.7 +/- 58.1 vs -22.7 +/- 50.6, P = 0.40) between patients with and without contiguous fQRS. At a mean follow-up of 4.4 +/- 1.9 years, there were a total of 89 deaths, 22 (44.0%) in patients with contiguous fQRS and 67 (36.8%) without (log rank P = 0.31). CONCLUSIONS: QRS fragmentation is not a predictor of progressive ventricular remodeling or mortality in heart failure patients undergoing CRT.
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机译:背景:QRS碎片(fQRS)已被证明是左心功能不全患者瘢痕的标志。尚不清楚fQRS是否与进行心脏再同步治疗(CRT)的患者进行性左心室重构和死亡率增加相关。方法:我们回顾了2001年12月至2006年11月之间233例接受CRT装置新植入的患者的植入前和随访超声心动图。如果患者的CRT前ECG带有适当的滤镜设置(滤镜0.16-100或0.16-150 Hz,25 mm / s,10 mm / mV),左心室射血分数(LVEF) = 40%,以及纽约心脏协会II-IV级标准药物治疗症状。两名不知情的评论者对12导联心电图(ECG)解释为fQRS的存在。比较有和没有连续性fQRS的患者之间的重塑终点,包括LVEF和左室舒张末期(LVEDV)和收缩期(LVESV)的变化,并评估了全因死亡率。结果:232例患者符合入选标准,其中50例在连续导联中表现出fQRS。 LVEF(%)(7.9 +/- 12.9 vs 6.8 +/- 11.0,P = 0.60)的改善或LVEDV(mL)的降低(-30.1 +/- 57.2 vs -15.7 +/- 47.6)没有差异或没有连续fQRS的患者之间的LVESV(mL)(-33.7 +/- 58.1 vs -22.7 +/- 50.6,P = 0.40)。平均随访时间为4.4 +/- 1.9年,共有89例死亡,其中连续性fQRS患者有22例死亡(44.0%),而无fQRS的患者有67例(36.8%)(log P = 0.31)。结论:接受CRT的心力衰竭患者QRS片段化不能预测其进行性心室重构或死亡率。
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