碎裂QRS波与宽QRS波对扩张型心肌病不良预后的预测价值OA

Objective To explore the predictive value of fragmented QRS waves(fQRS)and wide QRS waves(wQRS)for adverse prognosis in patients with dilated cardiomyopathy(DCM).Methods A total of 220 DCM patients were retrospectively selected and designated as DCM group.Based on electrocardiogram characteristics(QRS wave morphology and duration),they were further divided into fQRS group(88 cases),wQRS group(82 cases),and non-fragmented QRS wave(nfQRS)group(50 cases).Additionally,112 age-and sex-matched healthy individuals who under-went physical examinations during the same period were selected as healthy control group.The QRS wave characteristics and the occurrence of endpoint events were compared among the groups.The pri-mary endpoint events were composite cardiac events(cardiogenic death,sustained ventricular tachy-cardia/ventricular fibrillation,cardiogenic shock),and the secondary endpoint event was a decrease in left ventricular ejection fraction(LVEF)by ≥10％from the baseline level.A multivariate Cox proportional hazards model(adjusted for covariates)was used to analyze the independent predictors of composite cardiac events.Multiple comparisons were corrected using the Bonferroni method(sig-nificance threshold P＜0.025).Results The incidence of fQRS and wQRS in the DCM group was higher than that in the healthy control group,while the incidence of nfQRS was lower than that in the healthy control group,with statistically significant differences(P＜0.05).During the follow-up period,the incidence of cardiogenic death and sustained ventricular tachycardia/ventricular fibrilla-tion in the fQRS and wQRS groups was higher than that in the nfQRS group,with statistically signifi-cant differences(adjusted P＜0.025).The incidence of a ≥10％decrease in LVEF in the fQRS group was higher than that in the nfQRS group,with a statistically significant difference(adjusted P＜0.025),while there was no statistically significant difference in the incidence of a ≥10％de-crease in LVEF between the wQRS and nfQRS groups(adjusted P＞0.025).There was no statisti-cally significant difference in the incidence of cardiogenic shock among the subgroups(adjusted P＞0.025).Multivariate Cox regression analysis showed that fQRS(HR=2.75,P=0.019),N-termi-nal pro-B-type natriuretic peptide(NT-proBNP)≥1 500 pg/mL(HR=1.92,P=0.013),and serum potassium＜3.5 mmol/L(HR=2.10,P=0.002)were all independent predictors of com-posite cardiac events.wQRS was not included in the model due to severe collinearity with fQRS(va-riance inflation factor=8.2).Conclusion Both fQRS and wQRS are associated with adverse prognosis in DCM patients.Among them,fQRS can predict the occurrence of cardiogenic death and malignant arrhythmias and has independent predictive value in patients with narrow QRS waves.A combined analysis of QRS wave morphology and duration can provide a new strategy for high-risk stratification in DCM.