Characteristics of Fragmented QRS Waves and Their Correlations with Ventricular Arrhythmias in Patients with CHD During Treadmill Exercise Test
10.3870/j.issn.1672-0741.23.10.019
- VernacularTitle:冠心病患者运动平板试验中碎裂QRS波特点及其与室性心律失常的相关性
- Author:
Jing LING
1
;
Yao WU
;
Guoping TIAN
Author Information
1. 南华大学附属第二医院功能检查科,衡阳 421001
- Keywords:
coronary heart disease;
fQRS wave;
fQRS wave duration;
ventricular arrhythmia
- From:
Acta Medicinae Universitatis Scientiae et Technologiae Huazhong
2024;53(5):659-669
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the characteristics of fragmented QRS waves and their correlation with ventricular ar-rhythmias in coronary heart disease patients during treadmill exercise tests.Methods A total of 216 patients suspected of hav-ing coronary heart disease or clinically diagnosed at our hospital from November 2021 to October 2022 were selected for the study.The general clinical data,cardiac ultrasound indices,laboratory indices and ECG parameters of the subjects were collect-ed.The patients were divided into two groups according to the results of coronary angiography:coronary heart disease(CHD)group(n=152)and non-CHD group(n=64).According to the presence of the fQRS wave in the treadmill exercise test,the CHD group and non-CHD group were divided into the QRS group(without the fQRS wave)and the fQRS group(with the fQRS wave).For patients with confirmed CHD,the occurrence of ventricular arrhythmia within 12 months was observed,and the CHD group was divided into a ventricular arrhythmia group(n=80)and non-ventricular arrhythmia group(n=72).ROC curves were used to analyze the diagnostic efficacy of the fQRS wave in the exercise treadmill test for CHD.A logistic regres-sion model adjusted for confounding variables was used to explore the relationship between fQRS wave duration and the risk of ventricular arrhythmias in patients with CHD.Random forest algorithm was used to screen the possible influencing factors of ventricular arrhythmias,and the formula for predicting ventricular arrhythmia events was obtained according to the regression e-quation y=1-1/(1+e-x).Bootstrap method was used to verify the prediction model.Results In the exercise treadmill test,the incidence of fQRS wave in the CHD group(116/152,76.32％)was significantly higher than that in the non-CHD group(21/64,32.81％).In the exercise treadmill test,the maximum area under the ROC curve(AUC)of the fQRS wave for CHD was 0.899(P＜0.05),the sensitivity and specificity were 94.3％and 78.2％,respectively,and the Youden index was 0.725.In the CHD group,the duration of the QRS wave and fQRS wave after exercise was significantly longer than that before exercise,and the time limit of the fQRS wave before and after exercise was significantly longer than that of the QRS wave(P＜0.05).Compared with those of the QRS group,the proportions of two-vessel and multi-vessel lesions of the fQRS group were greater,and the proportions of severe stenosis and complete occlusion were greater than those of the QRS group.The Gensini score of the fQRS group was greater than that of the QRS group.In the exercise treadmill test,the duration of the fQRS group before and after ex-ercise was positively correlated with the Gensini score.In the CHD group,the incidence of ventricular arrhythmias in the fQRS group(77/116,66.38％)was significantly higher than that in the QRS group(3/36,8.33％).The duration of the fQRS wave be-fore and after exercise was positively correlated with the risk of ventricular arrhythmia in patients with CHD.Conclusion The incidence of fQRS waves is significantly increased,and the duration of fQRS waves is significantly prolonged in patients with CHD during the treadmill exercise test.The fQRS wave has a certain value in predicting the degree of CHD and CAD.The fQRS wave and its duration in the exercise treadmill test are positively correlated with the risk of ventricular arrhythmia in pa-tients with CHD.
