Fragmented QRS and ejection fraction in heart failure patients admitted to the hospital

Abstract

BackgroundFragmented QRS (FQRS) in 12 lead ECG was recently correlated with various outcomes in ischemic and non-ischemic heart disease. We studied the relationship between FQRS and ejection fraction (EF) in heart failure patients with QRS<120ms. MethodsMedical records and echocardiograms of 339 patients admitted with CHF were reviewed. ECGs were read twice by a reader blinded to all data. Results70 patients with wide QRS were excluded; 63 patients had FQRS and 206 patients did not have FQRS. FQRS group were more likely to be black (OR=2.17; p=0.0093), and diabetic (OR=1.79; p=0.0451). ROC curve analysis revealed a significant relationship between EF and FQRS (p=0.002). At EF of 48%, OR for FQRS was 4.36 (95% CI: 2.1–9.05; p<.0001). Adjustment for race and diabetes did not change the OR, or confidence intervals (Adjusted OR for race: 4.08 (95% CI: 1.06–15.67; p=0.04); for diabetes: 4.13 (95% CI: 1.46–11.69; p=0.008)). There was a significant difference in EF between patients with FQRS involving ≥2 ECG areas and non-FQRS group (p<0.05), but not between patients with ≥2 vs. one area, or 1 area vs. non-FQRS. ConclusionIn heart failure patients with QRS<120ms, FQRS was observed more frequently in persons of black race and in diabetics and was associated with lower EF. This was mainly seen in patients with FQRS involving ≥2 ECG areas.