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目的探讨碎裂QRS波群(f QRS)对扩张型心肌病(DCM)进展的预测价值。方法对154例DCM患者和154例健康对照组进行12导联心电图检查,根据心电图上是否存在f QRS波和QRS波的时限,将入选患者分为碎裂QRS波组(f QRS组)、宽QRS波组(w QRS组)和非碎裂QRS波组(nonf QRS组),比较f QRS波在DCM患者和健康对照组的发生率;比较观察组3种QRS波形态的发生率,比较f QRS组、w QRS组和nonf QRS组患者的左室射血分数(LVEF)降低、心律失常、心源性死亡的发生率。结果观察组中f QRS波发生率显著高于健康对照组(P<0.001);观察组中f QRS波和w QRS波的发生率显著高于nonf QRS波的发生率(P<0.05);f QRS组和w QRS组的LVEF降低、心律失常、心源性死亡发生率明显高于nonf QRS组(P<0.05)。多变量Cox回归分析显示:f QRS波对DCM的影响有统计学意义(P<0.001)。结论 f QRS可成为心电图诊断DCM进展的新指标,是DCM患者心血管事件的预测因子。
Objective To investigate the predictive value of fragmented QRS complex (f QRS) on the progression of dilated cardiomyopathy (DCM). Methods Fifty-four patients with DCM and 154 healthy controls were examined by 12-lead electrocardiogram. The patients were divided into fragmented QRS wave group (f QRS group) according to the presence or absence of f QRS wave and QRS wave on the electrocardiogram QRS wave group (QRS wave group) and non-fragmented QRS wave group (nonf QRS group), comparing f QRS wave incidence in patients with DCM and healthy control group; comparison of observation group, the incidence of three kinds of QRS wave morphology, compared with f Left ventricular ejection fraction (LVEF), arrhythmia, and cardiac death among patients in QRS, w QRS, and nonf QRS groups were reduced. Results The incidence of f QRS wave in observation group was significantly higher than that in healthy control group (P <0.001). The incidence of f QRS wave and w QRS wave in observation group was significantly higher than that in nonf QRS wave (P <0.05); f QRS and w QRS decreased LVEF, arrhythmia and cardiac death were significantly higher than nonf QRS group (P <0.05). Multivariate Cox regression analysis showed that f QRS wave had a significant effect on DCM (P <0.001). Conclusions f QRS can be a new indicator of the progress of DCM in the diagnosis of DCM and is a predictor of cardiovascular events in patients with DCM.