Fragmented QRS complexes not typical of a bundle branch block: A marker of greater myocardial perfusion tomography abnormalities in coronary artery disease

Abstract

Fragmented QRS (FQRS) complexes, not typical of a bundle branch block, are a marker of regional myocardial injury. The extent of stress myocardial perfusion imaging (MPI) abnormalities with FQRS patterns is not known. Twelve-lead electrocardiograms (ECGs) in 501 patients undergoing stress MPI were studied. FQRS was defined as a QRS duration of 120 milliseconds or less, with notches or slurs of QRS complexes, on 2 contiguous leads of a coronary artery territory. Abnormal MPI was defined as a regional summed stress score (SSS) and summed rest score (SRS) of 3 or greater based on a 17-segment model. Patients with a typical bundle (n = 26), paced rhythm (n = 2), and Q waves (n = 64) were excluded. Of the remaining 409 patients (mean age, 58 +/- 13 years; 52% male), 155 (38%) had FQRS on the ECG. FQRS patients had a higher mean SSS, SRS, and global summed difference score and a lower left ventricular ejection fraction (all P < .001), as well as greater regional stress MPI scar (69% vs 11%, P < .001). FQRS pattern sensitivity was 75% and specificity was 94% for a corresponding regional MPI scar. On logistic regression, SSS, SRS, summed difference score, left ventricular ejection fraction, and regional scar were univariate predictors of the FQRS pattern on the ECG (all P < .01), and any regional scar (odds ratio, 32; P < .001) was a multivariate predictor. FQRS complexes on an ECG are a marker of higher stress MPI perfusion and functional abnormalities. Regional FQRS patterns denote the presence of a greater corresponding focal regional myocardial scar on stress MPI.