Fragmented QRS Predicts Heart Failure Progression in Patients With Hypertrophic Cardiomyopathy
Fragmented QRS Predicts Heart Failure Progression in Patients With Hypertrophic Cardiomyopathy
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DOI：
10.1253/circj.cj-14-0822
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发表时间：
2015-01-01
影响因子：
3.3
通讯作者：
Hayashi, Kenshi
中科院分区：
文献类型：
--
作者：
Nomura, Akihiro;Konno, Tetsuo;Hayashi, Kenshi
背景资料：尽管反映心室内传导延迟的碎裂QRS波群（frag-QRS）已被证明是心脏事件的预后标志物，但关于frag-QRS对肥厚型心肌病（HCM）心脏事件的影响的数据很少：94例HCM患者（56例男性，平均年龄58 ± 17岁）进行了回顾性研究。Frag-QRS定义为在至少2个相邻的ECG导联中存在不同的RsR'模式。主要心源性事件（MAE）定义为心源性猝死和合并持续性室性心动过速/室颤。在临时或常规医学检查期间根据ECG诊断新发房颤（AF）。心力衰竭（HF）住院定义为因主观或客观症状而住院。31例患者（33%）检测到Frag-QRS。TNNI 3是最常见的致病基因。中位随访时间为4.6年。心源性死亡、MAE、新发AF和HF住院的4年累积生存率分别为97.6%、94.6%、87.5%和89.3%。在多变量分析中，片段-QRS与住院的HF显著相关（校正的风险比[95%置信区间]：5.4 [1.2-36]，P=0.03）。此外，无HF生存率在片段-QRS（+）组显著低于片段-QRS（-）组（79.0% vs.95.1%，P=0.03）。结论：片段-QRS与HCM患者的HF住院相关，HCM患者具有独特的基因突变分布。
Background: Although fragmented QRS complex (frag-QRS) reflecting intra-ventricular conduction delay has been shown to be a prognostic marker for cardiac events, few data exist regarding the impact of frag-QRS on cardiac events in hypertrophic cardiomyopathy (HCM).Methods and Results: Ninety-four HCM patients (56 male; mean age, 58 +/- 17 years) were retrospectively investigated. Frag-QRS was defined as the presence of various RsR' patterns in at least 2 contiguous ECG leads. Major arrhythmic events (MAE) were defined as sudden cardiac death, and combined sustained ventricular tachycardia/ ventricular fibrillation. New-onset atrial fibrillation (AF) was diagnosed based on ECG during provisional or routine medical examination. Heart failure (HF) with hospitalization was defined as hospital admission due to subjective or objective symptoms. Frag-QRS was detected in 31 patients (33%). TNNI3 was the most frequent disease-causing gene. Median follow-up was 4.6 years. The 4-year cumulative survival rates of cardiac death, MAE, new-onset AF and HF with hospitalization were 97.6%, 94.6%, 87.5% and 89.3%, respectively. On multivariate analysis, frag-QRS was significantly associated with HF with hospitalization (adjusted hazard ratios [95% confidence intervals]: 5.4 [1.2-36], P=0.03). Moreover, HF-free survival was significantly lower in the frag-QRS (+) group compared to the frag-QRS (-) group (79.0% vs. 95.1%, P=0.03).Conclusions: Frag-QRS is associated with HF with hospitalization in HCM patients who had a unique distribution of gene mutations.