Abstract

 

OBJECTIVES

Fragmented QRS (fQRS), related to myocardial fibrosis, is an important prognostic marker of cardiovascular events and mortality. Aortic stenosis (AS), the most frequent valvular heart disease in developed countries, causes myocardial fibrosis due to ventricular pressure overload. The current study aimed to investigate whether fQRS is associated with long-term mortality after isolated surgical aortic valve replacement (SAVR) in patients with severe AS.

METHODS

A total of 289 patients who underwent SAVR for severe AS between May 2009 and January 2020 with interpretable electrocardiogram were included. Patients were divided into 2 groups according to the presence of fQRS. Kaplan–Meier survival analyses were used to detect cumulative survival rates. Univariable and multivariable Cox proportional hazards models were used to determine the predictors of all-cause mortality.

RESULTS

fQRS occurred in 126 (43.5%) patients. A total of 59 (20.4%) patients died over a follow-up period of 54 ± 32 months. All-cause mortality was higher in the fQRS group (23 [14.1%] vs 36 [28.6], log-rank test P = 0.002) in the long term. The presence of fQRS [hazard ratio (HR): 1.802, confidence interval (CI): 1.035–3.135, P = 0.037], electrocardiographic left ventricular strain (HR: 1.836, CI: 1.036–3.254, P = 0.038) and history of stroke or transient ischaemic attack (HR: 3.130, CI: 1.528–6.412, P = 0.002) were independent predictors of all-cause mortality in the multivariable Cox regression model.

CONCLUSIONS

fQRS is associated with a 1.8-fold increase in long-term mortality in patients undergoing isolated SAVR for severe AS. Detecting fQRS in electrocardiograms may provide prognostic information about the long-term outcomes.

中文翻译：

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碎片化 QRS 波群可预测严重主动脉瓣狭窄患者单纯手术主动脉瓣置换术后的长期死亡率

摘要

 

目标

与心肌纤维化相关的碎片 QRS (fQRS) 是心血管事件和死亡率的重要预后标志物。主动脉瓣狭窄（AS）是发达国家最常见的瓣膜性心脏病，由于心室压力超负荷导致心肌纤维化。目前的研究旨在调查 fQRS 是否与严重 AS 患者单纯手术主动脉瓣置换术 (SAVR) 后的长期死亡率相关。

方法

共纳入 289 名在 2009 年 5 月至 2020 年 1 月期间因严重 AS 接受 SAVR 并具有可解释心电图的患者。根据是否存在 fQRS 将患者分为 2 组。Kaplan-Meier 生存分析用于检测累积生存率。单变量和多变量 Cox 比例风险模型用于确定全因死亡率的预测因子。

结果

126 名 (43.5%) 患者出现 fQRS。在 54 ± 32 个月的随访期内，共有 59 名 (20.4%) 患者死亡。从长期来看，fQRS 组的全因死亡率更高（23 [14.1%] vs 36 [28.6]，对数秩检验P  = 0.002）。fQRS 的存在 [风险比 (HR): 1.802, 置信区间 (CI): 1.035–3.135, P  = 0.037], 心电图左心室应变 (HR: 1.836, CI: 1.036–3.254, P  = 0.038) 和病史中风或短暂性脑缺血发作（HR：3.130，CI：1.528-6.412，P  = 0.002）是多变量 Cox 回归模型中全因死亡率的独立预测因子。

结论

fQRS 与因严重 AS 接受单独 SAVR 的患者的长期死亡率增加 1.8 倍相关。在心电图中检测 fQRS 可以提供有关长期结果的预后信息。