碎裂QRS波与急性ST段抬高型心肌梗死患者自主神经功能及左室重构的关系

Relationship between fragmented QRS complex and autonomic nerve function and left ventricular remodeling in patients with acute ST-segment elevation myocardial infarction

摘要:

目的： 探讨急性ST段抬高型心肌梗死（ST-segment elevation myocardial infarction，STEMI）患者碎裂QRS波（fragmented QRS complex，fQRS）与心脏自主神经功能及左室重构的相关性。方法： 回顾性分析华中科技大学同济医学院附属普爱医院心内科住院的STEMI患者170例，根据心电图上是否存在fQRS分为nfQRS组94例和fQRS组76例。分析患者基本临床资料、24 h动态心电图指标及超声心动图数据等，比较2组患者之间的差异。结果： 与nfQRS组相比，fQRS组心率变异性（heart rate variability，HRV）指标24 h正常窦性R-R间期标准差（standard deviation of NN intervals，SDNN）、24 h内每5min窦性R-R间期均值标准差（standard deviation of all 5-min average NN intervals，SDANN）、极低频（very low frequency，VLF）、低频（low frequency，LF）、低频与高频功率比值（ratio of low frequency to high frequency power，LF/HF）明显降低（P<0.05）；左室功能指标左室射血分数（left ventricular ejection fraction，LVEF）明显低于nfQRS组，而左室舒张末期内径（left ventricular end-diastolic dimension，LVEDD）、N-端脑钠肽前体（N-terminal pro brain natriuretic peptide，NT-proBNP）明显高于nfQRS组（P<0.01）。多因素logistic回归分析，经校正年龄、性别后，SDNN、SDANN、VLF、LF、LF/HF、LVEF降低及NT-proBNP升高是STEMI患者发生fQRS的危险因素。Spearman相关分析显示，STEMI患者SDNN、SDANN、VLF、LF、LF/HF、LVEF与fQRS呈显著负相关，而LVEDD、NT-proBNP与fQRS呈显著正相关（P<0.01）。结论： 心电图上存在fQRS的STEMI患者，心肌缺血较严重，心脏自主神经功能损伤明显，左室重构显著。

Abstract:

Objective: To investigate the association of fragmented QRS complex (fQRS) with cardiac autonomic nerve function and left ventricular remodeling in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods: A retrospective analysis was performed on 170 STEMI patients hospitalized in the cardiology department of our hospital. According to the presence of fQRS on the ECG, patients were divided into nfQRS group (n=94) and fQRS group (n=76). Basic clinical data, 24 h dynamic ECG indicators and echocardiography data were analyzed to compare the differences between the patients of the two groups. Results: Compared with the nfQRS group, the values of standard deviation of NN intervals (SDNN), standard deviation of all 5-min average NN intervals (SDANN), very low frequency (VLF), low frequency (LF), ratio of low frequency to high frequency power (LF/HF) of heart rate variability (HRV) in the fQRS group were significantly decreased (P<0.05); the left ventricular ejection fraction (LVEF) of left ventricular function of the fQRS group was significantly lower than that of the nfQRS group, while the left ventricular end-diastolic dimension (LVEDD) and N-terminal pro brain natriuretic peptide (NT-proBNP) values were significantly higher than those of nfQRS group (P<0.01). Multiple logistic regression analysis showed that after adjusting for age and gender, reduced SDNN, SDANN, VLF, LF, LF/HF, LVEF and increased NT-proBNP were risk factors for fQRS in STEMI patients. Spearman correlation analysis showed that SDNN, SDANN, VLF, LF, LF/HF, LVEF were significantly negatively correlated with fQRS in STEMI patients, while LVEDD, NT-proBNP were significantly positively correlated with fQRS (P<0.01). Conclusion: In STEMI patients with fQRS on ECG, myocardial ischemia is serious, cardiac autonomic nerve function damage is obvious, and left ventricular remodeling is significant.