The Study On The Relationship Between Fragmented QRS And Coronary Disease

ObjectiveThe myocardial tissues in patients with heart disease the occurrence of damage, such as the formation of myocardial ischemia, myocardial necrosis or myocardial scar tissue, myocardial tissue activation order change or because of the electrical activity of some myocardial depolarization rate caused by the delay, the myocardial tissues of living heterogeneity increases, which is fragmented QRS different forms on the surface ecg. Fragmented QRS refers to the body surface electrocardiogram in patients with heart disease of the three-phase QRS wave or polyphase wave, and the exclusion of complete and incomplete bundle branch block and intraventricular block. The purpose of this study is through the analysis of ECG in fragmented QRS relationship between the lesions and coronary artery stenosis, the diagnosis significance of fragmented QRS complex in patients with coronary heart disease and the clinical value. Acute myocardial infarction(AMI) and other patients with coronary heart disease after percutaneous coronary intervention(PCI) after treatment, patients with ischemic myocardium blood supply improvement in body surface ECG QRS wave, fragmentation may also change, so, in comparison of ECG in patients with preoperative and postoperative appearance of fragmented QRS complex changes in the ratio of the situation, can distinguish the percutaneous coronary intervention(PCI) on the blood supply of ischemic myocardium in the improvement of whether there is a very significant role. MethodsThis study collected from 2012 November to 2013 October 255 cases a year of income of Shandong province Qianfo Hill Hospital Department of cardiology hospital treatment of patients, and all patients underwent selective coronary artery angiography, PCI operation, twelve lead body surface electrocardiogram, ultrasound Heartbeat diagram, blood biochemical examination, and exclusion of atrial fibrillation, bundle branch block, and the other may cause interference case. This study retrospectively analyzed 255 patients(male 171 cases, female 84 cases). Findings were grouped according to the results of coronary angiography in patients with selective right coronary artery, including single branch lesion of right coronary artery lesion group(the degree of stenosis greater than 50%) and multi vessel disease(multivessel disease complicated with right coronary artery lesions in patients with non), right coronary artery disease patients include the presence of anterior descending branch lesions, circumflex artery and anterior descending branch and circumflex lesions in patients with coronary disease; three main vessel(left anterior descending artery, the left circumflex branch and right coronary artery) stenosis degree of the most serious stenosis is more than 70%, the patients were divided into single vessel lesion, double vessel lesions and multivessel lesion group; according to narrow horizontal three major vessels in the most serious areas were divided into 50%~75% group, 75%~99% group and complete occlusion group. According to the surface ECG QRS wave have no cracks appear, the patients were divided into fragmented QRS group and non fragmented QRS wave group. According to the degree of coronary artery stenosis and complete occlusion group, group 75%~99%, group PCI patients before and after the operation ratio of fragmented QRS wave of electrocardiogram in comparison. All data were analyzed with fragmented QRS wave(the degree of stenosis of coronary artery disease, narrow range, the relationship between the stenosis site), and the patients after PCI operation, fragmentation of QRS wave change ratio. ResultsIn this study, a total of 255 patients, ECG appears fragmented QRS total of 61 patients(23.92%), no fragmentation of QRS wave in 194 patients(76.08%).1.The lesion In this study, 255 patients with a total of 61 patients with ECG are fragmented QRS wave, QRS wave appears in the lower wall fracture were 54 cases, fragmented QRS appear on the side wall in 3 cases, fragmentation of QRS wave appeared in the anterior wall in 4 cases. Lateral wall and anterior wall and inferior wall P values were less than 0.05, with statistical significance, comparing the anterior wall and lateral wall, f QRS wave showed no statistical significance. Comparison of right coronary artery in group Ⅱ, Ⅱ, a VF lead f QRS wave incidence and non right coronary artery group, P value is greater than 0.05, no statistical significance2. The extent of coronary artery diseaseIn this study, 255 patients, three coronary artery disease patients with a total of 51 patients, the ECG fragmented QRS wave in patients with a total of 18 patients with multi vessel disease group, fragmented QRS wave occurrence ratio was 35.29%; all patients with 2 vessel coronary disease patients, there were 89 cases, the electrocardiogram QRS wave fragmentation occurred in patients with a total of 20 cases, double vessel lesion group fragmented QRS appearance rate for 22.47%; all patients in 1 patients with coronary artery lesions were seen in 112 patients, the ECG fragmented QRS wave in patients with a total of 23 cases, single branch lesions group fragmented QRS wave ratio of 20.54%, the rate of fragmented QRS complex appears on surface electrocardiogram in patients with multi vessel disease group, compared with the single branch lesions group, P < 0.05, with statistical significance.3. The degree of coronary artery stenosisThree main coronary artery(anterior descending coronary artery LCD, circumflex branch of right coronary artery LCX, RCA), selective coronary angiography showed a total of 71 patients with coronary artery stenosis is 50~75%, in which a total of 9 patients with ECG QRS wave appears broken, fragmented QRS appearance rate for 12.68%; selective coronary angiography in all patients showed at least 1 lesions in a coronary artery stenosis of 75~99% patients with a total of 135 patients, the ECG QRS wave in fractured patients 40 cases, fragmentation of QRS wave appear rate for 29.63%; angiography and selective coronary artery in all patients showed at least one branch of coronary artery complete occlusion of patients with a total of 44 cases, the electrocardiogram QRS wave appear broken in 12 cases, fragmentation of QRS wave appeared ratio of 27.27%. Body surface electrocardiographic fragmentation rate of QRS waves, the degree of stenosis in patients in group 75%~99% and at least in patients with coronary artery occlusion, respectively, and the degree of stenosis were compared to the group of patients with 50%~75%, P values were less than 0.05, are statistically significant.4. Patients with PCI before and after operation of fragmented QRS complex situationIn this study, 255 cases of selective coronary artery angiography showed in patients with at least one branch of coronary artery stenosis of 75~99% patients with a total of 135 patients, the ECG occurred in 40 cases of QRS patients for wave fragmentation, fragmentation of QRS wave appeared ratio was 29.63%, postoperative body surface electrocardiogram in patients with PCI still had 26 cases of fragmentation for patients with QRS wave, QRS wave appeared fragmentation ratio was 19.26%; there were 44 cases of patients with coronary artery angiography showed at least one branch of coronary artery occlusion, the fragmented QRS 12 patients ECG, QRS wave appeared fragmentation ratio 27.27%, after PCI operation, electrocardiogram still fragmentation QRS wave in 4 cases, fragmentation of the emergence of QRS ratio of 9.09%. PCI in patients in two groups before and after the surface ECG QRS wave appeared fragmentation rate were statistically significant, P values were less than 0.05. Conclusions1.Fragmentation QRS waves in the inferior, predictive significance in the diagnosis of coronary artery disease, but not to conclude that the right coronary artery was the culprit vessel.2. Emergence of ECG of fragmented QRS can range the reaction of coronarylesions and the severity of stenosis, can help clinicians diagnose incident myocardial infarction and early warning of the heart.3. PCI after the operation of coronary artery stenosis parts supply location of myocardial ischemia significantly improved, fragmentation of QRS wave ratiodecreased significantly, so the improved PCI operation on myocardial ischemiahas significant effect.