Abstract
Background: Fragmented QRS (fQRS) results from myocardial scarring and predicts cardiovascular mortality and ventricular arrhythmia (VA). We evaluated the prevalence and prognostic value of fQRS in Asian patients hospitalized for heart failure.Methods and Results: This was a retrospective cohort study of adult patients hospitalized for heart failure between 1st January 2010 and 31st December 2016 at a tertiary center in Hong Kong. The baseline ECG was analyzed. QRS complexes (<120 ms) with fragmented morphology in ≥2 contiguous leads were defined as fQRS. The primary outcome was a composite of cardiovascular mortality, VA, and sudden cardiac death (SCD). The secondary outcomes were the components of the primary outcome, myocardial infarction, and new-onset atrial fibrillation. In total, 2,182 patients were included, of whom 179 (8.20%) had fQRS. The follow-up duration was 5.63 ± 4.09 years. fQRS in any leads was associated with a higher risk of the primary outcome (adjusted hazard ratio (HR) 1.428 [1.097, 1.859], p = 0.001), but not myocardial infarction or new-onset atrial fibrillation. fQRS in >2 contiguous leads was an independent predictor of SCD (HR 2.679 [1.252, 5.729], p = 0.011). In patients without ischaemic heart disease (N = 1,396), fQRS in any leads remained predictive of VA and SCD (adjusted HR 3.526 [1.399, 8.887], p = 0.008, and 1.873 [1.103, 3.181], p = 0.020, respectively), but not cardiovascular mortality (adjusted HR 1.064 [0.671, 1.686], p = 0.792).Conclusion: fQRS is an independent predictor of cardiovascular mortality, VA, and SCD. Higher fQRS burden increased SCD risk. The implications of fQRS in heart failure patients without ischaemic heart disease require further studies.
Highlights
First described by Boineau and Cox in 1973, fragmented QRS is the manifestation of myocardial scarring on 12lead surface electrocardiogram (ECG) [1, 2]
Though initially described in the context of ischaemic heart disease (IHD), fragmented QRS (fQRS) has been observed in other conditions where myocardial scarring or fibrosis is present, such as hypertrophic cardiomyopathy and cardiac sarcoidosis [2, 3]
As data on the prevalence and long-term prognostic power of fQRS in Asian patients hospitalized with heart failure are lacking, we aimed to bridge this gap in evidence with the current study
Summary
First described by Boineau and Cox in 1973, fragmented QRS (fQRS) is the manifestation of myocardial scarring on 12lead surface electrocardiogram (ECG) [1, 2]. While fQRS has been shown to be predictive of adverse cardiovascular outcomes in patients with heart failure [4], most studies have focused on either acute outcomes of hospitalized patients, or long-term outcomes of ambulatory patients [6, 7]. As data on the prevalence and long-term prognostic power of fQRS in Asian patients hospitalized with heart failure are lacking, we aimed to bridge this gap in evidence with the current study. Fragmented QRS (fQRS) results from myocardial scarring and predicts cardiovascular mortality and ventricular arrhythmia (VA). We evaluated the prevalence and prognostic value of fQRS in Asian patients hospitalized for heart failure
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