| Objective:Coronary atherosclerotic heart disease(CHD) is caused by abnormal lipids metabolism,lipid in the blood is deposited on the smooth intima to form atheromatous plaques,it lead to coronary artery luminal stenosis or occlusion and myocardial ischemia or necrosis, Causing abnormal cardiac metabolism and function. With China’s material life level increased,the social problems such as work pressure,irrational way of life, an ageing population growing.As one of the most serious cardiovascular diseases threatening the elderly health,the incidence of coronary heart disease (CHD) showed an upward trend and the age of onset was younger trend, Its prognosis and complications is mainly correlated to the position, degree and scope of lesions.It plays an important role in improving patients’prognosis, controlling of disease development, prolonging survival time and improving the quality of life that early detection and evaluation of disease with the timely and effective treatment. Coronary angiography-Because of its accuracy, intuitive, etc-has become the "gold standard" for diagnosis of coronary heart disease. Nevertheless,it’s popularity similar existence certain resistance for it’s invasive, expensive cost, the technical requirements and risk. Electrocardiography(ECG) has a long history, it occupies an indispensable position in the diagnosis of coronary heart disease for its rapid,effective,convenient,inexpensive, noninvasive and repeatable, etc. The ventricular depolarization and conduction velocity reduced When myocardial ischemia, myocardial necrosis or scar tissue formation, forming a variety of irregular QRS wave- The fragmented QRS complex(fQRS). The purpose of this study is to realize the clinical value of fQRS in CHD through analysising the relationship between fQRS and the pathological changes of coronary artery,guiding clinical diagnosis and treatment.Methods:Selected 486 patients from Jan.2015 and Dec.2015 in YuXi people’s hospital,who has been performed coronary angiography, Echocardiography, resting electrocardiogram (ECG) and serologic examinations, eliminated the influence factors like bundle branch block or intraventricular blocks,cardiomyopathy, ventricular preexcitation wave,ventricular hypertrophy, electrolyte disturbances,congenital heart disease and so on. All patients underwent a coronary angiography and were classed into two groups:normal coronary group(stenosis less than50%) and coronary heart disease group (stenosis greater than or equal to 50%).According to whether fQRS patients were divided into fQRS group and non fQRS groups. According to Gensini integral,degree of coronary artery stenosis(defined by the most serious stenosis of the three main coronary artery and its branches), culprit artery, patients were divided into less than 40 points,40-80, and more than 80 points groups, less than 50% group, 50-74% group,75-99% group,and occlusion group,respectively. Comprehensive all data to investigate the correlation between fQRS and the scope and degree of coronary artery stenosis and culprit artery.Results:This study included 486 patients, of whom a clear diagnosis’of coronary heart disease (coronary artery lesion severity 50% or higher) 394 cases, the normal coronary (coronary_artery lesion severity less than 50%) 92 cases.According to whether fQRS divided into fQRS group 240 cases (coronary heart disease 220 cases) and no fQRS group 246 cases (coronary heart disease 174 cases).1 the scope of coronary artery stenosisCoronary heart disease (CHD) patients have been divided into fQRS group and no fQRS group, the Gensini score (< 40 group,40-80 group,> 80 group) proportion of two groups respectively 74 (33.6%) Vs 93 (53.4%),88 (40.0%) Vs 51 (29.3%),58 (26.4%) Vs 30 (17.2%), the two groups had a significant difference, P<0.05.Normal coronary group(stenosis< 50%),as well as coronary heart disease patients were divided into< 40 group,40-80 group and> 80 group according to the Gensini score, comparison of fQRS detection rate among four groups respectively is 20(21.7%),74 (44.3%),88 (63.3%),and 58 (65.9%), except the comparison between 40-80 group and> 80 group was no statistically significant difference(p>0.05), The rest of the comparison between adjacent groups, the difference was statistically significant (P< 0.05). Coronary heart disease (CHD) patients, Gensini score< 40 group and 40-80 group fQRS appeared leads compared(Z= 3.204, P= 0.001);40-80 group compared with> 80 group fQRS appeared leads(Z= 3.676, P= 0.000).2 The degree of coronary artery stenosisThe degree of stenosis (< 50%,50-74%,75-99%, totally occluded) proportion of fQRS group and non-fQRS group were respectively 20 (8.3%) Vs 72 (29.3%),34 (14.2%) Vs 47 (19.1%),107 (44.6%) Vs 96 (39.0%),79 (32.9%) Vs 31 (12.6%),< 50% lesions proportion in fQRS group was less than non-fQRS group with statistical difference(p< 0.05). There was no significant difference between 50-74% and 75-99%(P≥0.05).According to the degree of stenosis patients is divided into< 50%,50-74%, 75-99% and occlusion groups, Comparison between the four groups fQRS detection rate is respectively 20(21.7%),34 (42.0%),107 (52.7%) and 79 (71.8%) difference between< 50% group and occlusion group have statistical significance(p< 0.05).while there was no statistical significance between the other two groups(p≥0.05). Coronary heart disease (CHD) patients, fQRS appeared leads for comparison between 50-74% and 75-99% groups:Z=-2.414, P=0.000,between 75-99% and occlusion groups:Z=-3.970, P=0.000.3 Lesion vesselComparing fQRS group with non-fQRS group,the proportion of left anterior descending lesion, left circumflex artery lesion and right coronary artery lesion, Respectively,197 (89.5%) Vs 158 (90.8%),137 (62.3%) Vs 105 (60.3%).166 (75.5%) Vs118 (67.8%), differences were not statistically significant(p>0.05).Conclusions:1. The emergency of fQRS on a 12-lead ECG in a CHD patients, To some extent, can predict the scope and degree of coronary artery stenosis,and Assist clinicians to assess patient’s condition,then choose the the most appropriate treatment.2. The number of leads with fQRS also have certain predictive value in the scope and degree of coronary artery stenosis in CHD patients.3. fQRS have certain value in diagnosis of coronary artery lesions,but we can’t clear the lesion vessel in accordance with its corresponding leads.4. The fQRS detection rate in adult male is higher than women. |
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