Relationship between fragmented QRS wave with ventricular arrhythmia's incidence situation and heart rate variability in patients with old myocardial infarction / 中国综合临床

Objective:To explore the relationship between fragmented QRS complex and heart rate variability (HRV) and ventricular arrhythmia in patients with old myocardial infarction.Methods:From August 2018 to October 2019, 200 patients with old myocardial infarction were first treated in the Department of cardiac function examination of the First Affiliated Hospital of Hebei North University. The patients were divided into 99 cases of old myocardial infarction with fragmented QRS wave group and 101 cases of old myocardial infarction without fragmented QRS wave group according to the case bank data and conventional 12 lead ECG diagnosis in our hospital for the first time. Then, the 24-h ambulatory ECG reexamined within 1 year after discharge was retrospectively analyzed. The incidence of ventricular arrhythmia was compared between the two groups by χ 2 test. The difference of heart rate variability between the two groups was compared by rank sum test. Multiple logistic regression was used to analyze the value of different indexes of heart rate variability in the evaluation of fragmented QRS complex in old myocardial infarction. Drawing the receiver operating characteristic (ROC), and the area under the curve (AUC) was used to analyze the diagnostic accuracy of different indexes of heart rate variability in the broken QRS complex of old myocardial infarction. Results:According to the Lown classification of ventricular premature contraction, the number of positive ventricular arrhythmias in patients with Grade Ⅰ of ventricular premature contraction and Grade Ⅲ-Ⅴ of ventricular premature contraction in the old myocardial infarction fragmented QRS group was higher than that in the old myocardial infarction non fragmented QRS group (Grade Ⅰ of ventricular premature contraction: 54.5% (54/99)and 39.6%(40/101); χ 2=4.484, P<0.05;Grade Ⅲ-Ⅴ of ventricular premature contraction: 34.3% (34/99) and 9.9%(10/101); χ 2=17.406, P<0.05)). Ventricular premature contraction Grade 0 old myocardial infarction fragmented QRS group was lower than old myocardial infarction non fragmented QRS group (8.1% (8/99) and 48.5% (49/101); χ 2=37.995, P<0.05). The total number of positive cases of ventricular arrhythmia in the old myocardial infarction group with fragmented QRS wave was higher than that in the old myocardial infarction group without fragmented QRS wave (91.9% (91/99) and 51.5%(52/101); χ 2=57.146, P<0.05)). There was no significant difference in the number of positive ventricular arrhythmias between the old myocardial infarction fragmentation QRS group and the old myocardial infarction non fragmentation QRS group ( P>0.05). The standard deviation of NN intervals (SDNN) and the standard deviation of average NN intervals (SDANN) of HRV time domain indexes in the old myocardial infarction fragmented QRS group were higher than those in the old myocardial infarction non fragmented QRS Group (SDNN:143.00(122.00,166.00) vs. 110.00(95.00,130.50), Z=5.780, P<0.05; SDANN:112.00(100.00,136.00) vs. 96.00(76.00,118.50), Z=4.013, P<0.05). Multiple Logistics regression analysis results of HRV domain shows that HRV time domain SDNN and SDANN have diagnositic value in diagnosis fQRS after OMI(SDNN: OR=0.949, 95% CI:0.922-0.977, P<0.001; SDANN: OR=1.036, 95% CI:1.005-1.068, P=0.022). Area under ROC curve of HRV time domain SDNN and SDANN have particular diagnositic accuracy in diagnosis fQRS after OMI(SDNN: AUC 0.737, 95% CI 0.666-0.807, Sensitivity 0.818, Specificity 0.634; SDANN: AUC 0.664, 95% CI 0.587-0.741, Sensitivity 0.737, Specificity 0.673. 0.5<AUC<1). Conclusion:Fragmented QRS complex was positively correlated with the incidence and severity of ventricular arrhythmia in patients with old myocardial infarction, and positively correlated with time-domain indexes SDNN and SDANN of heart rate variability in patients with old myocardial infarction.

Association Between Non-Dipping and Fragmented QRS Complexes in Prehypertensive Patients / Associação entre Ausência de Descenso da Pressão Arterial Durante o Sono e a Fragmentação do Complexo QRS em Pacientes Pré-Hipertensos

Abstract Background: Fragmented QRS (fQRS) is a sign of adverse cardiovascular events in various cardiovascular diseases. It is also associated with increased blood pressure and non-dipping in hypertensive patients. However, no study has investigated the importance of fQRS in prehypertensive patients. Objectives: The aim of our study is to investigate the relationship between fQRS and non-dipper status in prehypertensive patients. Methods: Two hundred and sixteen eligible, newly diagnosed prehypertensive patients who underwent 24-hour ambulatory blood pressure monitoring (ABPM) for further evaluation of blood pressure between June 2015 and July 2016 were included into the study. Patients were divided into three groups according to ABPM results: normotensives, dipper prehypertensives, and non-dipper prehypertensives. Groups were compared regarding presence of fQRS on electrocardiography. Additionally, multinomial logistic regression analysis was used to determine the relationship between fQRS and blood pressure pattern in prehypertensive patients. Results: According to ABPM recordings, 61 patients had normotensive blood pressure pattern (systolic blood pressure < 120 mmHg and diastolic blood pressure < 80 mmHg). Of the remaining 155 prehypertensive patients, 83 were dippers and 72 were non-dippers. Non-dipper prehypertensives had a significantly higher frequency of fQRS compared to normotensives (p = 0.048). Furthermore, multinomial logistic regression analysis revealed that fQRS is an independent predictor of non-dipping blood pressure pattern in prehypertensive patients (p = 0.017, OR: 4.071, 95% CI: 1.281-12.936). Conclusions: We found that fQRS is a predictor of non-dipping in prehypertensives. As a marker of fibrosis and higher fibrotic burden within myocardium, fQRS may be useful in identifying high-risk prehypertensive patients before the development of hypertension.

Resumo Fundamento: A fragmentação do QRS (fQRS) é um sinal de eventos cardiovasculares adversos em várias doenças cardiovasculares. É associado também à pressão arterial elevada e à ausência de descenso da pressão arterial durante o sono (non-dipping) em pacientes pré-hipertensos. Objetivos: O objetivo do estudo presente é investigar a relação entre fQRS e ausência de descenso da pressão arterial durante o sono em pacientes pré-hipertensos. Métodos: Duzentos e dezesseis pacientes elegíveis, recém-diagnosticados com pré-hipertensão, que foram submetidos a monitorização ambulatorial da pressão arterial (MAPA) durante 24 horas para avaliação mais aprofundada da pressão arterial entre junho de 2015 e julho de 2016, foram incluídos no estudo. De acordo com os resultados da MAPA, os pacientes foram divididos em três grupos: normotensos, pré-hipertensos com descenso da pressão arterial durante o sono (padrão dipping) e pré-hipertensos com ausência de descenso da pressão arterial durante o sono (padrão non-dipping). Os grupos foram comparados quanto à presença de fQRS no eletrocardiograma. Adicionalmente, utilizou-se a análise de regressão logística multinomial para determinar a relação entre a fQRS e o padrão de pressão arterial em pacientes pré-hipertensos. Resultados: De acordo com os registos da MAPA, 61 pacientes apresentavam padrão de pressão arterial normotenso (pressão arterial sistólica < 120 mmHg e pressão arterial diastólica < 80 mmHg). Dos 155 pacientes pré-hipertensos, 83 tinham padrão dipping e 72 tinham padrão non-dipping. Os pacientes pré-hipertensos com padrão non-dipping tinham uma frequência significativamente mais alta de fQRS em comparação com os pacientes normotensos (p = 0,048). Além disso, a análise de regressão logística multinomial revelou que fQRS é um preditor independente do padrão non-dipping de pressão arterial em pacientes pré-hipertensos (p = 0,017, OR: 4,071, 95 % CI: 1,281-12,936). Conclusões: Verificamos que a fQRS é um preditor do padrão non-dipping em pacientes pré-hipertensos. Como marcador de fibrose e aumento na carga fibrótica do miocárdio, a fQRS pode ser útil na identificação de pacientes pré-hipertensos de alto risco antes do desenvolvimento da hipertensão.

Distribution characteristics of fragmented QRS in patients with coronary atherosclerotic heart disease and its relationship with left ventricular remodeling / 上海交通大学学报（医学版）

Objective: To explore the diagnostic value of fragmented QRS (fQRS) for coronary atherosclerotic heart disease (CHD), and to analyze it's relationship with left ventricular remodeling. Methods: From Nov. 2016 to Oct. 2018, 498 hospitalized patients in the Department of Cardiovascular Medicine of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine were selected consecutively. During the hospitalization, all the patients underwent coronary angiography. According to the angiographic results, the patients were divided into the control group (203 patients with negative or coronary stenosis < 30%), the mild to moderate stenosis group (155 patients with coronary stenosis 30% to 75%), and the severe stenosis group (140 patients with coronary stenosis≥75%). The incidences of fQRS(+) in the normal electrocardiogram among the three groups were compared by chi-square test of R×C contingency table. Two hundred and thirty patients with single-vessel stenosis≥30% were divided into the anterior descending branch group (128 cases), the right coronary branch group (59 cases), and the circumflex branch group (43 cases), and the relationship between fQRS(+) leads and diseased vessels was analyzed by nonparametric test. Finally, all the patients were divided into fQRS(+) group (86 cases) and fQRS(-) group (412 cases). The correlation between fQRS and left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), interventricular septum thickness (IVST) and left ventricular posterior wall thickness (LVPWT), respectively, were analyzed by binary Logistic regression model. Results: The chi-square test of R×C contingency table showed that the incidences of fQRS(+) in the three groups were 8.89%, 16.13% and 30.71%, respectively, with statistically significant differences (all P < 0.05). The nonparametric test showed that the fQRS(+) leads reflecting the anterior wall (V3, V4) were more common in the anterior descending branch group, and the fQRS(+) leads reflecting the interior wall and right ventricular (Ⅱ, III, AVF, V1, V2) were more common in the right coronary branch group, the fQRS(+) leads reflecting upper lateral wall (, AVL) were more common in the circumflex branch group, with statistically significant differences (all P<0.05). Binary Logistic regression analysis showed that fQRS was negatively correlated with LVEF (r=-0.030, OR=0.971, 95% CI 0.945-0.997, P=0.029), and positively correlated with LVESV (r=0.042, OR=1.043, 95% CI 1.005-1.082, P=0.026). Conclusion: fQRS has certain reference value in the clinical diagnosis of CHD, and left ventricular remodeling may be one of the mechanisms of fQRS.

The effect of fragmented QRS complex on the early left ventricular remodeling and heart function in patients with acute myocardial infarction / 天津医药

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.

The value of fragmentation QRS wave in rat myocardial infarction model / 安徽医科大学学报

To set up rat myocardial infarction model and to investigate significance of fragmented QRS wave in rat myocardial infarction model.40 rats were divided into sham-operated group and myocardial infarction group, these two sets of rats received surgeries under the same conditions.Myocardial infarction models were induced by opening chest and anterior descending branch of coronary artery deligation for rats.Rats in sham-operated group were only threaded without deligation.Recorded the electrocardiogram(ECG) during 10, 60 min and 4 weeks after the deligation(or threading) and analyzed the change rules of the fragmented QRS waves and Q waves.Tissue samples from myocardial infarction area were collected for HE staining 4 weeks after the surgery.The frequency of fragmented QRS wave in myocardial infarction group was significantly increased during 10, 60 min and at 4 weeks after the operation compared with sham-operated group(P<0.01).Myocardial cells of some models in myocardial infarction group arranged in disorder and showed vacuolation according to results of HE staining.By setting up rat myocardial infarction model, we can draw a conclusion that fragmented QRS wave can be used as a new indicator to diagnose acute myocardial infarction and old myocardial infarction predict the severity of the disease.

Fragmented QRS for Risk Stratification in Patients Undergoing First Diagnostic Coronary Angiography / QRS Fragmentado para Estratificação de Risco em Pacientes Submetidos à Primeira Angiografia Diagnóstica

Abstract Background: Only a small proportion of patients referred for coronary angiography with suspected coronary artery disease (CAD) have the diagnosis of obstructive CAD confirmed by the exam. For this reason, further strategies for risk stratification are necessary. Objective: To investigate the relationship of the presence of fragmented QRS (fQRS) on admission electrocardiogram with angiographically detected CAD and CAD severity in patients without known vascular diseases and myocardial fibrosis, undergoing first diagnostic coronary angiography. Methods: We enrolled 336 consecutive patients undergoing coronary angiography for suspected CAD. The patients were divided into two groups according to the presence or absence of fQRS on admission. We compared the groups regarding the presence and severity of CAD. Results: Seventy-nine (23.5%) patients had fQRS on admission. There was not a statistically significant difference between patients with fQRS (41.8%) and non-fQRS (30.4%), regarding the presence of CAD (p = 0.059). However, there was a statistically significant difference between patients with fQRS and non-fQRS regarding the presence of stenotic CAD (40.5% vs. 10.5%, p<0.001) and multi vessel disease (25,3% vs. 5.1%, p<0.001). The frequency of fQRS was significantly higher in patients with SYNTAX score >22 compared to patients with SYNTAX score ≤22. Conclusions: Our findings suggest that fQRS may be an indicator of early-stage myocardial damage preceding the appearance of fibrosis and scar, and may be used for risk stratification in patients undergoing first diagnostic coronary angiography

Resumo Fundamento: Somente uma pequena proporção dos pacientes com suspeita de doença arterial coronariana (DAC), encaminhados para realizarem angiografia coronária, tem o diagnóstico de DAC obstrutiva confirmado pelo exame. Por isso, outras estratégias de estratificação de risco são necessárias. Objetivo: Investigar a relação da presença de QRS fragmentado (QRSf) no eletrocardiograma na admissão com DAC detectada por angiografia e gravidade da DAC em pacientes sem diagnóstico de doenças vasculares, ou fibrose miocárdica, submetidos à primeira angiografia coronária de diagnóstico. Métodos: Recrutamos 336 pacientes consecutivos que se submeteram à angiografia coronária por suspeita de DAC. Os pacientes foram divididos em dois grupos de acordo com a presença ou ausência de QRSf na admissão. Nós comparamos os grupos quanto à presença e gravidade de DAC. Resultados: Setenta e nove (23,5%) pacientes apresentaram QRSf na admissão. Não houve diferença estatisticamente significativa entre pacientes com QRSf (41.8%) e sem QRSf (30,4%) (p = 0,059) quanto à presença de DAC. No entanto, houve uma diferença estatisticamente significativa entre pacientes com e sem QRSf quanto à presença de DAC (40.5% vs. 10.5%, p < 0,001) e de doença de múltiplos vasos (25,3% vs. 5,1%, p < 0,001). A frequência de QRSf foi significativamente maior em pacientes com escore SYNTAX > 22 em comparação a pacientes com escore SYNTAX ≤ 22. Conclusões: Nossos achados sugerem que o QRSf pode ser um indicador de danos iniciais no miocárdio antecedendo o aparecimento de fibrose e cicatrização, e pode ser usado para estratificação de risco em pacientes submetidos à primeira angiografia coronária de diagnóstico.

Relationship of fragmented QRS complexes with inflammation in patients with acute coronary syndromes / 安徽医科大学学报

To analyze the correlation between fragmented QRS complexes( fQRS) and inflammation in 136 patients with acute coronary syndromes(ACS). Patients with fQRS had increased hs-CRP levels (P<0.01) in comparison to patients with non-fragmented QRS. The higher hs-CRP levels was,the more the number of leads in the fQRS on ECG was(P<0.01). When we performed multiple logistic regression analysis, fQRS was found to be related to in-creased hs-CRP levels [ OR:1.507 , 95% CI:1.172~1.936 , P<0.01 ] . fQRS was independently related to in-creased hs-CRP. fQRS that may result as an end effect of inflammation at cellular level can represent increased car-diac risk in patients with ACS.

ST segment depression fQRS may be a new predictor of mortality of non-ST elevation myocardial infarction / 重庆医学

Objective To observe the incidence of fragmented QRS complex (fQRS)and ST Segment depression fQRS (STD fQRS)during the first 48 hours after non-ST elevation myocardial infarction(NSTE MI)and discuss the value of predicting mortality in patients with NSTE MI .Methods Based on the ECGs ,the patients with NSTE MI were divided into two groups :fQRS and non fQRS group .And then fQRS group was divided into two sub-groups :STD fQRS and non-STD fQRS group .Their mortality was studied during long-term follow-up .Results (1)731 patients with NSTE ACS [the NSTE MI group(n=609) and the UA group(n=122)] were studied .The incidence of fQRS in the NSTE MI group was higher than that of the UA group .(2)All cause mortality in the fQRS group were higher than that in the non-fQRS group ,and all-cause mortality in the STD fQRS group were higher than that in the non-STD fQRS group ,all the above results were not only in the early stages of NSTE MI ,but also in the long term fol-low-up .(3) Multivariate Cox regression analysis revealed that STD fQRS was an independent significant predictor for all cause mortality ,but not of the fQRS .Conclusion The STD fQRS may be an independent predictor of mortality in patients with NSTE MI .

The prognostic value of fragmented QRS in the recurrance of cardiac events in acute myocardial infarction patients underwent emergency percutaneous coronary intervention / 中国介入心脏病学杂志

Objective To study the prognostic value of fragmented QRS (fQRS) in the recurrence of cardiac events in acute STEMI patients underwent emergency percutaneous coronary intervention (PCI). Methods Ninety-two acute STEMI patients who underwent emergency PCI were enrolled. The presence of fQRS was evaluated by a 12-lead ECG in 72 h after PCI. Cardiac events (myocardial infarction, need for revascularization or cardiac death) and all-cause mortality were recorded in all patients during 12 months follow-up. Results Cardiac event rate[15 (31.3%) vs. 4 (9.1%)]were higher in the fQRS group (n=48) compared with the non-fQRS group (n=44) during a mean follow-up of 12 months. A Kaplan-Meier survival analysis revealed significantly lower event-free survival for cardiac events in the fQRS group (P < 0.004). The results of Cox regression model analysis revealed that signiifcant fQRS was an independent signiifcant predictor for cardiac events (HR 2.19, 95%CI 1.38-3.50, P=0.023). Conclusions The presence fQRS is an independent risk factor for poor prognosis in STEMI patients undergoing emergency PCI.

Complejo QRS fragmentado: Utilidad como predictor de riesgo cardiovascular y correlación con trastornos regionales de motilidad y anatomía coronaria / Fragmented QRS complex: Usefulness as a predictor of cardiovascular risk and correlation with motility disorders and coronary anatomy / Complexo QRS fragmentado: Utilidade como preditor de risco cardiovascular e correlação com distúrbios de motilidade e anatomia coronariana

Introducción. El QRS fragmentado (QRSf) representa un retraso en la conducción ventricular causada por una cicatriz miocárdica y podría asociarse a un mayor riesgo de mortalidad y eventos arrítmicos. Objetivo. Correlacionar el QRSf con trastornos de motilidad regional y su asociación con el resultado de la cinecoronariografía y obtener el valor clínico del QRSf para identificar población de riesgo en el curso de un síndrome coronario agudo (SCA). Materiales y métodos. Se evaluaron retrospectivamente pacientes ingresados en nuestra institución con diagnóstico de SCA. Se buscó en el electrocardiograma (ECG) la presencia de QRSf y se lo relacionó con el compromiso de la motilidad parietal por ecocardiograma y con la anatomía coronaria. Resultados. Se analizaron 116 pacientes, edad promedio de 64,6 años (75%, hombres), el 78,2% correspondió a SCA sin elevación del segmento ST, de los cuales el 36% tuvo QRSf, al igual que el 68% de los que tuvieron elevación del ST. El 47,4% del total de pacientes presentó QRSf. En el 72% de los pacientes con QRSf se observó algún trastorno de motilidad parietal en el ecocardiograma (p< 0,03). En el 28% de los casos, se evidenció una correlación entre la región con QRSf en el ECG y la región hipoquinética o aquinética por ecocardiograma. La mortalidad global intrahospitalaria fue del 6,9%; de los cuales el 12,5% mostró QRSf. De los pacientes con enfermedad de más de un vaso, el 74,2% evidenció QRSf (p< 0,05), mientras que el 41% presentó enfermedad de tres vasos. Conclusiones. El QRSf se asoció de manera significativa a la presencia de enfermedad de más de un vaso y shock cardiogénico, pero no con la mortalidad. Encontramos una significativa asociación entre la presencia de trastornos regionales de contractilidad y la anatomía coronaria, pudiendo relacionar entre sí datos ecocardiográficos, hemodinámicos e imagenológicos.

Introduction. The fragmented QRS (fQRS) represents a ventricular conduction delay caused by a myocardial scar and may be associated with an increased risk of mortality and arrhythmics events. Objective. The fQRS correlate with regional motility disorders and their association with the outcome of coronary angiography and get fQRS clinical value to identify the population at risk in the course of an acute coronary syndrome (ACS). Materials and methods. It retrospectively evaluated patients admitted our institution with a diagnosis of ACS. Searched the electrocardiogram (ECG) the presence of fQRS and related it to the commitment of wall motion by echocardiography and coronary anatomy. Results. There were evaluated 116 patients, average age 64.6% years (75% male). The 78.2% corresponded to ACS without ST segment elevation, of which 36% had fQRS, like 68% that had ST elevation. Among the whole of patients, the 47.4% presented fQRS. In 72% of patients showed some kind of parietal motility disorders in echocardiogram (p< 0.03). The 28% of remaining cases had demonstrated the correlation between the wall with fQRS in the ECG and the hypokinetic or akinetic area by echocardiogram. The in-hospital global mortality was of 6.9%, of which 12.5% had fQRS. Among the patients with more than one vessel disease, 74.2% showed fQRS (p< 0.05) and 41% presented three vessels disease. Conclusions. The fQRS was associated significantly with the presence of more than one vessel disease and cardiogenic shock, but not with mortality. We found a huge association between the presence of regional contractility disorders and coronary anatomy, making possible the relationship between echocardiographic, hemodynamic and imaging data.

Introdução. O QRS fragmentado (QRSf) representa um atraso de condução ventricular causada por uma cicatriz do miocárdio e pode estar associada com um risco aumentado de mortalidade e de eventos arrítmicos. Objetivo. Correlacionar o QRSf com distúrbios de motilidade regionais e sua associação com o resultado da angiografia coronária e obter o valor clínico do QRSf para identificar populações em risco no curso de uma síndrome coronária aguda (SCA). Materiais e métodos. Foram avaliados retrospectivamente os pacientes internados em nossa instituição com um diagnóstico de SCA. Procurando a presença de QRSf no ECG e relacionado para o compromisso do movimento da parede por meio de ecocardiografia e anatomia coronária. Resultados. Foram avaliados 116 pacientes, com idade média de 64,6 anos (75% do sexo masculino), O 78,2% corresponderam a SCA sem elevação do segmento ST, dos quais 36% tinham QRSf, como 68% dos que tinham elevação de ST. O 47,4% dos pacientes presenteou QRSf. Em 72% dos pacientes com QRSf apresentavam algum transtorno de movimento da parede no ecocardiograma (p< 0,03). Em 28% dos casos foi encontrada uma correlação entre a região com QRSf no ECG e a região hipoquinética ou região acinético pelo ecocardiograma. Mortalidade hospitalar global foi do 6,9%, dos quais 12,5% com QRSf. Dos pacientes com doença de mais de um vaso arterial, o 74,2% apresentaram QRSf (p< 0,05), enquanto que o 41% tinham doença de três vasos. Conclusões. O QRSf significativamente associados com a presença da doença de mais de um vaso arterial e choque cardiogénico, mas não com a mortalidade. Encontramos uma associação significativa entre a presença de distúrbios de contratilidade regional e anatomia coronária, tornando possível a relação entre dados ecocardiográficos, hemodinâmicos e os de imagem.

Absence and Resolution of Fragmented QRS Predict Reversible Myocardial Ischemia With Higher Probability of ST Segment Resolution in Patients With ST Segment Elevation Myocardial Infarction

BACKGROUND AND OBJECTIVES: Fragmented QRS complexes (fQRS) are associated with increased morbidity and mortality. The causative relationship between fQRS and cardiac fibrosis has been shown, but whether the presence and the number of fQRS on admission of electrocardiogram (ECG) predicts ST segment resolution in patients undergoing primary percutaneous coronary intervention (p-PCI) has not been investigated until now. SUBJECTS AND METHODS: This study included one hundred and eighty-four consecutive patients with ST elevation myocardial infarction (STEMI) who underwent p-PCI. The presence or absence of fQRS on pre and post-PCI ECG and their relation with myocardial infarction and reperfusion parameters were investigated. RESULTS: Patients with fQRS on admission of ECG or newly developed fQRS after p-PCI had increased inflammatory markers, higher cardiac enzyme levels, increased pain to balloon time, prolonged QRS time, more extended coronary involvement and more frequent Q waves on ECG in comparison to patients with absence or resolved fQRS. The presence and higher number of fQRS on admission or post-PCI ECGs were significantly related with low percent of ST resolution and myocardial reperfusion parameters. The area under the receiver operating characteristics curve values for the presence and number of fQRS to detect Thrombolysis in Myocardial Infarction Blush Grade 0 and 1, were 0.682 and 0.703. CONCLUSION: In our study, fQRS was significantly related to infarction and myocardial reperfusion parameters before and after p-PCI. Successful myocardial reperfusion by p-PCI caused the reduction in number of fQRS and QRS time with higher ST resolution. fQRS may be useful in identifying the patients at higher cardiac risk with increased ischemic jeopardized or infarcted myocardium, and persistent or newly developed fQRS may predict low percent of ST segment resolution in patients undergoing p-PCI.

Relationship of the fragmented QRS and the fragmented QRS time limit with ventricular arrhythmia in old myocardial infarction / 中国医师进修杂志

ObjectiveTo explore the relationship of the fragmented QRS (fQRS) and the fQRS time limit with ventricular arrhythmia in old myocardial infarction (OMI) patients through contrasting the incidence of ventricular arrhythmia in OMI patients whether fQRS or not and ventricular arrhythmia in different fQRS time limit.MethodsAccording to the routine electrocardiogram,321 OMI patients were divided into group A (fQRS appearance,167 cases) and group B(fQRS non-appearance,154 cases).The lead with fQRS extense was ehosen and traced another 50 mm/s electrocardiogram,and 3 consecutive fQRS time limit were measured and them average was taken in group A.According to the fQRS time limit,the patients in group A were divided into 3 groups: group X( ≤0.100 s,96 cases),group Y (0.101-0.119 s,54 cases) and group Z( ≥0.120 s,17 cases).All the patients were continuously monitored with 24 hours dynamic electrocardiogram,and the incidence of ventricular arrhythmia was analyzed.ResultsThe incidence of ventricular arrhythmia in group A [ 78.4％ ( 131/167 ) ] was higher than that in group B [ 63.6％(98/154) ] (P＜ 0.01 ).The incidence of premature ventricular contraction(PVC) ＞ 720/24 hours in group A [ 28.7％(48/167 ) ] was higher than that in group B[ 17.5％(27/154) ] (P ＜ 0.05 ).The incidence of multifocal PVC,coupled PVC,nonsustained ventricular tachycardia and Lown 3-5 grades PVC was 16.2％ (27/167),33.5％ (56/167),12.0％ (20/167),34.1％ (57/167) in group A,7.8％ (12/154),21.4％ (33/154),4.5％(7/154),23.4％(36/154) in group B,there were significant differences between two groups (P＜ 0.05 ).The incidence of ventricular arrhythmia in group Z [ 100.0％( 17/17 ) ] was significantly higher than that in group Y [79.6％(43/54)] and group X [74.0％(71/96)](P＜ 0.05).The incidence of Lown 3-5 grades PVC in group Z[ 70.6％( 12/17 )] was significantly higher than that in group Y[ 42.6％(23/54)] and group X [ 22.9％(22/96) ],and the incidence of Lown 3-5 grades PVC in group Y was significantly higher than that in group X (P＜ 0.05).ConclusionsOMI patients with fQRS have higher incidence and severe degree in ventricular arrlhythmia than those without fQRS.With the fQRS time limit widened,PVC and Iown 3-5 grades PVC significantly increased.So fQRS is a new predicting index of OMI,and fQRS time limit has definite value in predicting the heart event for OMI patients.

Idiopathic ventricular fibrillation with fragmented QRS complex and J wave in resting electrocardiogram / 老年心脏病学杂志（英文版）

Objective To describe the clinical characteristics of idiopathic ventricular fibrillation (IVF) with fragmented QRS complex (f-QRS) and J wave in resting electrocardiogram. Methods We reviewed data from 21 case subjects in our hospital who were resuscitated after cardiac arrest due to IVF and assessed the prevalence of f-QRS and J wave in resting electrocardiogram (ECG). All the case subjects were classified among three groups based on the electrocardiographic morphology: group I, both f-QRS and J wave were observed (n = 6), group II, only J wave was observed (n = 9), group III, neither f-QRS nor J wave was observed (n = 6). Population characteristics, history of syncope or sudden cardiac arrest, incidence of ventricular fibrillation (VF), and circumstance of VF were evaluated among the three groups. Results The incidence of index events (syncope, survived cardiac arrest and VF episodes recorded in implantable cardioverter defibrillator (ICD) or pacemakers) was 13.4 ± 5.6 per-year in group I, 10.8 ± 3.9 per-year in group II, and 9.8 ± 4.2 per-year in group III. There were significant differences in incidences among the three groups, the most frequent index events were observed in group I. The hazard ratio for incidence was 3.2 (95%CI, 1.1-7.9; P = 0.01). The history and circumstance of the index events were different among the groups. In group I, all the index events occurred during sleep in early morning. In group II, four subjects suffered VF during strenuous physical activities or agitation state, two during sleep in early morning, three in usual activity. In group III, one subject suffered VF during sleep in early morning, one in agitation state, four in usual activity. Conclusions This study suggests that the IVF patients with the combined appearance of f-QRS and J wave in the resting ECG suffer an increased risk of VF, this subgroup of IVF patients has a unique clinical feature.

Influence of emergency PCI in different time windows to cardiac scar and cardiac function after myocardial infarction / 中国综合临床

Objective To observe the influence of emergency PCI in different time windows to cardiac scar and cardiac function after myocardial infarction. Methods One hundred and twenty-seven patients with acute myocardial infarction, who were treated in different time windows by emergency PCI, were enrolled into this study. The cases were divided into two groups according to the time when they took PCI after onset;group 3 hPCI included 66 patients had PCI at 3 h after onset and group 6 hPCI included 61 patients had PCI at 6 h. At 4th, 8th and 12th weeks, the fragmented QRS (fQRS) were observed by twelve synchronization cardiogram; ventricle wall movement strain rate were determined by cardiac speckle tracking imaging;left ventricular ejection fraction (LVEF)were measured by cardiac ultrasound to evaluate cardiac events and cardiac function after myocardial infarction. Results At 4th,8th and 12th weeks,the fQRS positive leads were significantly more in 6 hPCI group than 3 hPCI group ( P ＜ 0. 05 respectively ) . The ventricle wall movements strain rate and LVEF improved significantly in 3 hPCI group compared with 6 hPCI group (P ＜ 0. 05 ). Conclusions The earlier emergency PCI treatment was applied and the earlier the"criminal"blood vessels were opened ,the more ischemic myocardial cells were restored. Combination use of fQRS、 STI and LVEF examination could improve the diagnosis of cardiac scar formation and direct protective therapy.