心肌梗死的心电图诊断新进展孙英贤.pptVIP

Kaplan-Meier 生存分析 有fQRS组较无fQRS组 存活率明显降低 fQRS是心梗高危预警的新指标 Fragmented QRS on a 12-lead ECG: a predictor of mortality and cardiac events in patients with coronary artery disease.Das MK, etc.Heart Rhythm. 2007 4(11):1385-92. Usefulness of fragmented QRS on a 12-lead electrocardiogram in acute coronary syndrome for predicting mortality. Das MK, etc. Am J Cardiol. 2009 ;104(12):1631-7. 在STEMI和NSTEMI中 24h内出现fQRS预示死亡率增加 fQRS是急性冠脉综合征预测死亡率的新指标 Kaplan-Meier 生存分析显示 出现fQRS能缩短生存时间 fQRS、T波倒置、ST段降低 均能够独立预测死亡率 fQRS诊断STEMI和NSTEMI 中度敏感性（50-55%）和高特异性（96%） fQRS是ACS患者死亡率的 独立预测因子 Fragmented QRS compared with Q-waves in the assessment of myocardial infarct Michael Rich, MD1; Mark Willcox, MD1; Joseph Lindsay, MD2; Anthony Fuisz, MD2 Introduction Methods Discussion Conclusions References Michael, M; Das, M. Fragmented QRS on a 12-lead ECG is a Sign of Acute or Recent Myocardial Infarction. Circulation. 2006;114:II 512. Blackburn, H. Electrocardiographic classification for population comparisons: The Minnesota code. Journal of Electrocardiology. 1969;2:1, 5-9. Results EKG notching (fQRS) in the absence of bundle-branch block may be a marker of altered ventricular depolarization secondary to myocardial scar. Abnormal Q-waves have been the standard EKG marker of prior myocardial infarction (MI). Based on a comparison to myocardial scintigraphy1, it has been proposed that fQRS is more sensitive and therefore has a better negative predictive value than Q-waves in detecting prior MI. This study was designed to compare fQRS and Q-waves, with CMR using delayed contrast hyperenhancement (DCH), as a marker of MI. The EKG’s of 146 stable patients (mean age 61 years, 98 male) who underwent CMR, including quantification of the volume of DCH, were reviewed by 2 independent readers blinded to this measurement. They recorded the presence of fQRS using published criteria and the presence of Q waves using the Minnesota Code criteria2. A fQRS was deemed to be present when