The Effect Of Fragmented QRS Complex On The Left Ventricular Remodeling And Heart Function In Patients With Acute Myocardial Infarction In Short-term And Long-term

Objective To investigate the relationship between fragmented QRS(f QRS)complex and the left ventricular remodeling or heart function in patients with acute myocardial infarction(AMI)in short-term and long-term.We can konw the structure and function of the heart quickly and clearly,intervene and treat actively,and improve the prognosis of patients.Methods A total of 40 patients with AMI from February to August 2017 in CCU of the Second Hospital of Tianjin Medical University were enrolled in the study.They were divided into f QRS group and Non-f QRS group.The clinical data,ECG,laboratory indicators,coronary angiography results and real-time three-dimensional(RT-3D)echocardiography parameter in-hospital and 6-month follow-up period were collected.The difference of RT-3D echocardiography parameter between f QRS group and Non-f QRS group were analyzed in-hospital and at 6 month follow up.The changes of three-dimensional parameters were compared between hospitalization and6-month follow-up.At the same time,the influencing factors of left ventricular remodeling and heart function were discussed in the study.Results(1)Comparison between f QRS group and Non-f QRS group in short-term after PCI:Compared with Non-f QRS group,left ventricular end-systolic volume(LVESV)was significantly higher and left ventricular ejection fraction(LVEF)was significantly lower in f QRS group(P<0.01).There was no significant differences in Left ventricular end-diastolic volume(LVEDV).Several three-dimensional parameters including Tmsv16-SD(ms),Tmsv16-SD(%),Tmsv 16-Dif(ms)and Tmsv 16-Dif(%)in f QRS group were significantly higher than those in Non-f QRS group(P<0.01).There were no significant differences in Tmsv 12-SD(ms),Tmsv 12-SD(%),Tmsv 6-SD(ms),Tmsv 6-SD(%),Tmsv 12-Dif(ms),Tmsv 12-Dif(%),Tmsv 6-Dif(ms)and Tmsv 6-Dif(%)between two groups.(2)Comparison between f QRS group and Non-f QRS group in long-term after PCI:Compared with Non-f QRS group,left ventricular end-systolic volume(LVESV)was significantly higher and left ventricular ejection fraction(LVEF)was significantly lower in f QRS group(P<0.01).There was no significant difference in Left ventricular end-diastolic volume(LVEDV).Several three-dimensional parameters including Tmsv16-SD(%)and Tmsv 16-Dif(%)in f QRS group were significantly higher than those in Non-f QRS group(P<0.05).There were no significant differences in Tmsv16-SD(ms),Tmsv 12-SD(ms),Tmsv 12-SD(%),Tmsv 6-SD(ms),Tmsv 6-SD(%),Tmsv 16-Dif(ms),Tmsv 12-Dif(ms),Tmsv12-Dif(%),Tmsv 6-Dif(ms)and Tmsv 6-Dif(%)between two groups.(3)Comparison between short-term and long-term in f QRS group: Compared with hospitalization,left ventricular ejection fraction(LVEF)was significantly higher after 6 months(P<0.05).There were no significant differences in left ventricular end-systolic volume(LVESV)and Left ventricular end-diastolic volume(LVEDV).Several three-dimensional parameters including Tmsv16-SD(ms),Tmsv16-SD(%),Tmsv 16-Dif(ms)and Tmsv 16-Dif(%)during hospitalization were significantly higher than 6-month follow-up period(P<0.05).There were no significant differences in Tmsv 12-SD(ms),Tmsv 12-SD(%),Tmsv 6-SD(ms),Tmsv 6-SD(%),Tmsv 12-Dif(ms),Tmsv 12-Dif(%),Tmsv 6-Dif(ms)and Tmsv6-Dif(%)between hospitalization and 6-month follow-up period.(4)Comparison between short-term and long-term in Non-f QRS group: Compared with hospitalization,left ventricular ejection fraction(LVEF)was significantly higher after 6 months(P<0.05).There were no significant differences in left ventricular end-systolic volume(LVESV)and Left ventricular end-diastolic volume(LVEDV).There were no significant differences in Three-dimensional synchronization parameters including Tmsv16-SD(ms),Tmsv16-SD(%),Tmsv12-SD(ms),Tmsv 12-SD(%),Tmsv 6-SD(ms),Tmsv 6-SD(%),Tmsv 16-Dif(ms),Tmsv 16-Dif(%),Tmsv 12-Dif(ms),Tmsv 12-Dif(%),Tmsv 6-Dif(ms)and Tmsv 6-Dif(%)between hospitalization and 6-month follow-up period.(5)Logistic regression analysis showed that f QRS and age had effects on left ventricular remodeling,and f QRS was a risk factor for heart function.Conclusion Left ventricular remodeling is more obvious in patients with acute myocardial infarction complicated with f QRS in short-term and long-term,and the heart function is worse in patients with f QRS.The left ventricular remodeling and heart function were improved at long-term both f QRS group and Non-f QRS group,and the left ventricular remodeling was more significantly improved in the f QRS group.FQRS can predict left ventricular remodeling and heart function better.