Analysis Of Risk Factors Associated With QRS Fragmentation Complexes In Patients With Angina Pectoris

Background and objective:Angina pectoris is a serious acute cardiovascular disease,conditions of patients are usually complicated and deteriorated rapidly,which has a feature of high mortality.Heart failure and arrhythmia are two common complications of angina.Angina has become an important threat to public health.Therefore,how to discover related early warning parameters of deterioration in angina patients has an important clinical significance.The fragmented QRS complexes(fQRS)in electrocardiograph has a certain value in diagnosis and predication of myocardial infarction,arrhythmia and heart failure.FQRS is an independent predictor associated with sudden cardiac death or hospitalization for heart failure in patients.Meanwhile,the examination of fQRS is simple,repeatable,low-cost and easy to be discriminated,and it has gradually become one kind of hotspots of noninvasive diagnosis electrocardiograph indicators.Some studies now suggested that acute myocardial infarction with fQRS in the electrocardiograph has a higher incidence of all-cause mortality,heart failure and arrhythmia.However,there is little correlative study suggested the danger of the presence of fQRS in angina patients.Thus,our study explores the presence of fQRS and its risk factors in angina patients with coronary artery stenosis over 70 percent by retrospectively analyzing the clinical data of angina patients with coronary artery stenosis over 70 percent in coronary angiography database.Method:1.We retrospectively included 521 consecutive patients with coronary artery stenosis over 70% accompany angina from Jan.2016 to Dec.2016 in the cardiovascular department of the Second Affiliated Hospital of NanChang University.2.Patients registered to hospital were divided into experimental group(fQRS)and control group(NfQRS)depending on the presence of fragmented QRS complexes of the 12-lead electrocardiograph.3.We compared the baseline data,parameters of electrocardiograph,results of echocardiograph between the two groups.4.Spearman correlation analysis was used to evaluate the correlation between relative indicators and fQRS.5.Multivariate logistic regression was used to explore and analyze the correlation between the fragmented QRS complexes of electrocardiograph and various factors in patients with angina.Result:1.Compared with NfQRS group,the average age [(66.2±9.7)years old vs.(64.1±10.0)years old,p=0.002] and average level fasting plasma glucose [(5.9±2.0)mmol/L vs.(5.4±1.7)mmol/L,P=0.028] of the fQRS group were higher;2.Compared with NfQRS group,the duration of QRS waves of fQRS group was longer[(108.2±24.6)ms vs.(92.0±12.2)ms,p=0.004];3.Compared with NfQRS group,the fQRS group has a larger Right Atrial Dimension [(36.4±3.8)mm vs.(34.9±3.3)mm,p=0.001],larger Left ventricular end–diastolic dimension [(51.2±7.4)mm vs.(47.3±4.4)mm,p<0.001] and lower LVEF [(55.0±10.6)% vs.(60.2±8.2)%,p<0.001];4.Spearman correlation analysis showed that fQRS was positively correlated with higher age(r=0.096,p=0.029),higher fasting plasma glucose(r=0.111,p=0.011),longer duration of QRS waves(r=0.183,p<0.001),larger Left ventricular end–diastolic dimension(r=0.141,p=0.001),larger Left ventricular end –diastolic dimension(r=0.245,p<0.001)and lower LVEF(r=0.210,p<0.001),Atrial premature beats(r=0.021,p=0.636),ventricular premature beats(r=0.021,p=0.636)have not been found to have significant correlation with fQRS.5.Multivariate logistic regression analysis demonstrated that older age(OR=1.833,95%CI: 1.059?3.173,p=0.030),higher fasting blood glucose level(OR=1.999,95%CI: 1.024?3.902,p=0.042),longer duration of ORS waves(OR=2.422,95%CI: 1.380?4.250,p=0.002)and lower Left ventricular ejection fraction(OR=2.274,95%CI: 1.002?5.161,p=0.049)were independently related to the presence of fORS of electrocardiograph in angina patients with coronary artery stenosis over 70 percent,in which larger Left Ventricular End–Diastolic Dimension(OR=2.743,95%CI: 1.093?6.887,p=0.032)has highest correlation with the presence of fORS of electrocardiograph.Conclusion:This study suggested larger Left Ventricular End–Diastolic Dimension has highest correlation with the presence of fORS of electrocardiograph,and the lower Left ventricular ejection fraction,longer duration of QRS waves,higher age and higher fasting blood glucose level are independently related to the presence of fQRS in electrocardiograph in angina patients.The examination of fQRS is simple,rapid,repeatable,low-cost and easy to be discriminated,so it can be widely applied in clinical practice as a kind of noninvasive diagnosis electrocardiograph indicators,but its prognostic value for angina remains to be further explored.