Significance Of A Fragmented QRS Complex In Patients With Prior Myocardial Infraction And Left Ventriculer Hypertrophy In Hypertension

Background and Objective: Mithilesh K. Das introduce us a new concept: the Fragmented QRS Complexes (fQRSs) in circulation in may 2006(some types of different fQRS are shown below) and he presume that Fragmented QRS complexes (fQRSs), which include various RSR' patterns, without a typical bundle-branch block are markers of altered ventricular depolarization owing to a prior myocardial scar. He conclude that the fQRS on a 12-lead ECG is a marker of a prior MI, which has a substantially higher sensitivity and negative predictive value compared with the Q wave by a cohort of nuclear stress tests in which he calculate the sensitivity, specificity and negative predictive value by single photon emission tomography(SPECT). We know that QRS is the comprehend vector of double ventricle depolarization, any factors which change the ventricle depolarization will lead to the change of amplitude of vibration and the change of latitude of QRS. The speed of propogatin between ventricle cells, the speed of conduction of specific conduction system of the heart, the amount of depolarization ventricle cells in effect are the main influential factors of the formative of QRS, and these are influenced by the blood-supply of the myocardiam, the inflammation, the change of retrogression, the automic nerve of the heart and so on, and old myocardial infraction, the left ventricular hypertrophy of the hypertension are undoubtedly the common cause of these changes, which shown on the electrocardiogram is the change of morphological of QRS which reflect the ventricle depolarization.The12—lead ECG is one of the most widely used method to detect old myocardiac infraction up to now. but when the incidence of Q wave myocardiac infraction reduced obviously compare to the past because of virulence treatment, the use of thromboolytic drug and revascularization in first stage, correspondingly non-Q wave myocardiac infraction raise to some extent. and we have found that Q wave can recovery or disappear with time-lapse, besidesly their ECG have no stabile idio-signs. That often leads to impossible judgement. So, how to use the 12—lead ECG to increase the detection rate of old myocardiac infraction is extremely essential, especially when opacification and myocardium nuclear imaging are not so popular.Left ventricular hypertrophy. is the risk factor of Heart disease cardia insufficiency and cardiac arrhythmia,; it has substaintial clinical significance. Electrocardiography is convenient, easy to reproducibility and it is an important method to check left ventricular hypertrophy. Now commonly used criterion of left ventricular hypertrophy involve multi- leads, relate to multi- data, easily confuse. In clinical practice, a fragmented QRS complex can be found in patients with prior myocardial infraction and left ventriculer hypertrophy in hypertension, and whether or not it can be an auxiliary diagnosis method, there is few correlated report, so we made this retrospective study.Methods: Retrospective review was performed in 446 patients with prior myocardial infraction and 217 patients with high blood pressure, with case history and, make the paitients divide the old myocardial infarction and non-old myocardial infarction. Compare the significance of the fQRSs and pathology Q wave to diagnose the old myocardial infarction, apply the result of echocardiography, divide the high blood pressure groups into left ventricular hypertrophy group and non- left ventricular hypertrophy group. Compare the significance of fQRSs and left ventricular hypertrophy to diagnose the high blood pressure.Study population:CAD group: 446 patients are diagnosed as CAD in NANFANG HOSPITAL during 2002-2005, among which 37 cases and 19 ones are excuted because of bundle branh block or paced rhythm, 162 of remain were diagnosed as old myocardial infraction by CACG along with case history.hypertension group: 217cases are selected by random among patients who were diagnosed as HBP in NANFANG HOSPITAL during 2000-2006,among which 11 cases and 3 ones are excuted because of bundle branh block or paced rhythm, 98 of remain were diagnosed as LVH by UCG.InstrumenttationGE Marquette MAC5000 electrocardiograph digital flat angiography system (AXIOM Artis dTA, germany siemens) diasonography (Sequoia512 color Doppler B-scanner, frequency2～4MHz, American Acuson).Case selectionPatients with prior myocardial infraction or left ventriculer hypertrophy in hypertension, record the fundamental data: name,age,sex,CAD group besides blood-fat,blood sugar,smoking.All paients have 12- leads ECG (GE, Marquette. Wis; model Mac 5000; filter range, 0.16 to 100Hz; 25mm/s, 10mm/mv), diagnose standard according to LVMI (left vent ricular mass index )＞125 g/m~2 (male) or＞120 g/m~2(female), or (ISVd≥12mm and/or LVPWd≥12mm). myocardial infraction group besides Q- wave leads. ECG consistency 99.5%.EchocardiographyAccording to the international heart association and WHO recommend method, selected patients all got the Chordae tendineae of mitral valve Level M-image, recording IVSd, LVPWd, LVD, measureing LAD and LVD.Cardiac catheterizationAll paients in CAD group got cardiac catheterization recording pathological changes of coronary arteries. Judkin'smethod selectivity CAG, computer quantitative analysis, diagnostic criteria adopted lumina diameter stenosis≥50%.Standards 1 ECG criteria for pathological Q Waves: A pathological Q wave was considered present when it was＞0.04 seconds in duration or deeper than one fourth of the following R wave in voltage. 2 Hypertension was defined as a DBP 90 mm Hg and/or an SBP 140 mm Hg in accordance with the 1999 WHO-ISH guidelines for the management of hypertension. 3 Echocardiogram criteria for left ventriculer hypertrophy: left ventricular mass index(LVMI)＞125 g/ m2 (male) or＞120 g/m2(female), ISVd≥12mm and/or LVPWd≥12mm 4 ECG criteria for left ventriculer hypertrophy: RⅠ+SⅢ＞2.5mv, RaVL＞1.2mv and RaVF≥2.0mv, or RV5≥2.5mv, RV5 +SV1≥3.5 (female) / 4.0 (male) mv in accordance with the fifth edtion of clinical electrocardiography edited by Prof. Wan Huang. 5 Comoary angiographies were performed via the femoral artery. All the angiographies were interpreted by the consensus of two independent observers. Significant CAD was defined as≥50% stenosis of vessels in diameter. 6 Old myocardial infarction was difined as 3 months after acute myocardial infarction in accordance with the 2000 ACC/AHA guidelines for old myocardial infarction.Statistical methodsCategorical data are presented by mean±S. D (x±s), utilize SPSS 12.0 statistics software to analyze, comparison of means adopted one-way ANOVA, comparison of interclass-rate adoptedχ~2 -test. Variability size of test P＜0.05 (both).Results: fQRS has some degree of diagnostic value compared with Q wave for OMI and LVH in HBP compared with voltage criteria。Conclusion: The fQRS is associate with regional myocardial ischemia, the fibration of cardiac tissue and scarring, so it is easily occurrence in old myocardial infraction and left ventricular hypertrophy in hypertension., and has some diagnostic value for the two diseases.