碎裂QRS波群与肺栓塞患者死亡率和临床结局的相关性：一项更新的荟萃分析。
完整摘要 · 中文译文
目的：对心电图碎裂QRS波（fQRS）与肺栓塞（PE）患者死亡率及其他临床结局之间的关联，提供一项更新且方法学严谨的评估。 设计：对观察性研究进行的系统评价与荟萃分析，所有合并分析均采用DerSimonian-Laird随机效应模型。异质性采用I²统计量评估，I²>50%表示存在显著异质性。研究质量采用纽卡斯尔-渥太华量表（NOS）评估，发表偏倚通过漏斗图目测检查评估。 参与者：系统检索了PubMed、Embase、Web of Science和Cochrane Library，检索时间截至2025年8月13日。纳入探讨成年确诊PE患者中fQRS与结局（死亡率、心源性休克、治疗升级）之间关联的观察性研究。患者根据入院心电图是否存在fQRS进行分组。 主要和次要结局指标：主要结局为全因死亡率（院内及长期）。次要结局包括心源性休克和治疗升级（溶栓、外科取栓术或机械通气）。 结果：纳入5项研究，涉及1383名患者。所有纳入研究的纽卡斯尔-渥太华量表（NOS）评分均≥7分，表明方法学质量为中等至高等。碎裂QRS波（fQRS）的存在与院内死亡率（OR 3.40；95% CI 1.72 to 6.71；p=0.0004；I²=51%）、长期死亡率（OR 3.90；95% CI 1.80 to 8.47；p=0.0006；I²=47%）和心源性休克（OR 4.88；95% CI 1.70 to 14.01；p=0.003；I²=65%）风险增加显著相关。未发现与溶栓、手术取栓或机械通气的使用存在显著关联。漏斗图检查显示不对称性，提示可能存在发表偏倚；然而，正式检验受纳入研究数量少的限制。敏感性分析证实了主要结果的稳健性。所有合并估计值均来自从原始研究中提取的未调整效应量。 结论：在这项更新的荟萃分析中，fQRS是肺栓塞（PE）患者早期和晚期死亡率及心源性休克的一个稳健且易于获取的风险标志物。标准化心电图（ECG）判读可能有助于改善风险分层并指导早期强化管理。需要进一步大规模前瞻性研究，以在不同人群中验证这些发现，并建立该情况下fQRS评估的标准化标准。CRD420251127962。
完整摘要 · 英文原文
OBJECTIVES: To provide an updated and methodologically rigorous assessment of the association of fragmented QRS (fQRS) on ECG with mortality and other clinical outcomes in patients with pulmonary embolism (PE). DESIGN: Systematic review and meta-analysis of observational studies using a DerSimonian-Laird random-effects model for all pooled analyses. Heterogeneity was assessed using the I² statistic, with I²>50% indicating substantial heterogeneity. Study quality was evaluated using the Newcastle-Ottawa Scale (NOS), and publication bias was assessed by funnel plot inspection. PARTICIPANTS: A systematic search of PubMed, Embase, Web of Science and Cochrane Library was conducted up to 13 August 2025. Observational studies investigating the association between fQRS and outcomes (mortality, cardiogenic shock, treatment escalation) in adults with confirmed PE were included. Patients were classified based on the presence or absence of fQRS on admission ECG. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was all-cause mortality (in-hospital and long-term). Secondary outcomes included cardiogenic shock and treatment escalation (thrombolysis, surgical embolectomy or mechanical ventilation). RESULTS: Five studies involving 1383 patients were included. All included studies scored ≥7 on the NOS, indicating moderate-to-high methodological quality. The presence of fQRS was significantly associated with an increased risk of in-hospital mortality (OR 3.40; 95% CI 1.72 to 6.71; p=0.0004; I²=51%), long-term mortality (OR 3.90; 95% CI 1.80 to 8.47; p=0.0006; I²=47%) and cardiogenic shock (OR 4.88; 95% CI 1.70 to 14.01; p=0.003; I²=65%). No significant association was found with the use of thrombolysis, surgical embolectomy or mechanical ventilation. Funnel plot inspection revealed asymmetry, suggesting potential publication bias; however, formal testing was limited by the small number of included studies. Sensitivity analysis confirmed the robustness of the primary findings. All pooled estimates were derived from unadjusted effect sizes extracted from the primary studies. CONCLUSIONS: In this updated meta-analysis, fQRS was a robust and readily available risk marker for early and late mortality and cardiogenic shock in patients with PE. Standardised ECG interpretation may enhance risk stratification and guide early, intensive management. Further large-scale, prospective studies are warranted to validate these findings across diverse populations and to establish standardised criteria for fQRS assessment in this setting.CRD420251127962.