Fragmented QRS complex and nonresponse to cardiac resynchronization therapy: a meta analysis
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摘要: 目的 评估碎裂QRS波(fragmented QRS，fQRS)与心力衰竭患者接受心脏再同步化治疗(CRT)后无反应性之间的关联。方法 在PubMed、The Cochrane Library、Web of science、EMbase、中国知网、万方、维普网和中国生物医学文献服务系统数据库中全面检索从建库至2022年10月评估fQRS与CRT反应性的相关文献，由2名研究者独立筛选、提取文献，对纳入研究进行质量评价。RevMan 5.4和STATA/MP 14软件行荟萃分析，并且对研究结果进行发表偏倚分析。结果 总纳入6篇研究，纳入研究之间异质性无统计学意义，荟萃分析结果显示CRT治疗前fQRS的存在与CRT治疗无反应性相关(OR=1.58，95%CI1.27~1.95，P < 0.001)。此外，针对fQRS的存在对CRT植入后左室收缩末期容积和左室舒张末期容积改善程度进行亚组分析，合并效应量分别为(MD=23.24，95%CI6.88~39.60，P=0.005，I2=0%)和(MD=20.60，95%CI2.75~38.46，P=0.02，I2=0%)。结论 fQRS与CRT无反应相关。Abstract: Objective To assess whether fragmented QRS(fQRS) is an predictor of nonresponse to cardiac resynchronization therapy(CRT) in patients with heart failure.Methods Two investigators independently performed a comprehensive search on topics that assesses fQRS and its association with nonresponse to CRT and remodeling up until May 2022. Meta-analyses were performed with RevMan 5.4 and STATA/MP 14, and publication bias analyses were performed on the findings.Results In a total of 6 studies, the results of the meta-analysis showed that the presence of fQRS was related to non-response to CRT(OR=1.58, 95%CI, 1.27-1.95, P < 0.001). In addition, the results of subgroup analysis showed that the presence of fQRS also associated with left ventricular end systolic volume(LVESV) and left ventricular end diastolic volume(LVEDV) reduction after CRT, and the pooled effect amounts were(MD=23.24, 95%CI6.88-39.60, P=0.005, I2=0%)and(MD=20.60, 95%CI2.75-38.46, P=0.02, I2=0%) respectively.Conclusion Fragmented QRS is associated with nonresponse to cardiac resynchronization therapy and ventricular remodeling after CRT.
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Key words:
- fragmented QRS /
- cardiac resynchronization therapy /
- meta analysis
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图 2 fQRS波与CRT无反应关系的森林图
Figure 2. Forest diagram of no response relationship between fQRS wave and CRT
图 3 fQRS波与CRT后LVESV、LVEDV关系的森林图
Figure 3. Forest diagram of the relationship between fQRS wave and LVESV, LVEDV after CRT
图 4 fQRS波与CRT后LVEF关系的森林图
Figure 4. Forest diagram of the relationship between fQRS wave and LVEF after CRT
图 5 fQRS与LVEF关系相关荟萃分析纳入研究的敏感性分析图
Figure 5. Sensitivity analysis in the relationship between fQRS and LVEF
表 1 6篇fQRS与CRT反应性相关研究的基本特征
Table 1. Basic characteristics of 6 studies on the correlation between fQRS and CRT reactivity
研究 研究设计 患者特征 总人数/例 fQRS总人数/例 QRS时限/ms QRS时限/ms(fQRS/non-fQRS) LBBB/% 缺血性心肌病/% 随访时间/月 CRT反应性标准 NOS评分/分 Celikyurt，2012 前瞻性队列研究 纽约分级Ⅲ~Ⅳ级，LVEF≤35%，QRS宽度≥120 ms，全部患者有LBBB 53 17 - 143±13/138±13 100 44 6 LVESV减少≥15% 8 Rad，2013 前瞻性队列研究 纽约分级Ⅲ~Ⅳ级，LVEF≤35%，QRS宽度≥120 ms 65 27 - 142.6±13.5/137.4±11.8 - - 3~6 LVESV减少≥15% 8 Celikyurt，2013 病例对照研究 纽约分级Ⅲ~Ⅳ级，LVEF≤35%，QRS宽度≥120 ms，全部患者有LBBB 105 48 146±18 - 100 39 6 LVESV减少≥15% 7 Nesti，2020 病例对照研究 纽约分级Ⅱ~Ⅲ级，LVEF≤35%，QRS宽度≥120 ms，全部患者有LBBB，植入CRTD 178 74 161±18 - 100 36 6 LVESV减少≥15%或LVEF增多≥10% 6 Suszko，2019 病例对照研究 纽约分级Ⅱ~Ⅳ级，LVEF≤35%，QRS≥120 ms伴LBBB或无LBBB伴QRS≥150 ms，植入CRTD 47 25 173±32 - 87 34 6 LVEF比基线水平增高 > 5% 6 Rickard，2011 回顾性队列研究 纽约分级Ⅱ~Ⅳ级，LVEF≤40% 232 86 161.8±29.5 174.5±27.2/158.3±29.2 43 52 11.6±9.0 LVEF、LVEDV、LVESV的显著改变 7 注：LBBB表示左束支传导阻滞；-表示未能获取的数据。 
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