P1867Diagnostic value of fragmented QRS complex and early repolarization pattern in detecting myocardial fibrosis and inflammatory

Abstract

Abstract Myocardial fibrosis (MF) and inflammatory (MI) play a significant role in pathogenesis of arrhythmias, heart failure and sudden cardiac death. Endomyocardial biopsy (EMB) and cardiac magnetic resonance with late gadolinium enhancement (CMRI-LGE) are used to detect this structural abnormalities. These methods are very informative but not a screening. ECG patterns: fragmented QRS complex (fQRS) and early repolarization (ERP) can be used as markers of MF and MI. Purpose To analyze the relationship between structural changes of myocardium, determined using by CMRI-LGE and EMB and fQRS and ERP. Materials and methods We analyzed results of CMRI-LG, EMB and 12-lead ECG in 46 patients (28 male, median age – 47.3±12.7). We used the criteria by Das M., 2006 to identify FQRS and the criteria by Macfarlane P.W., 2015 to identify ERP. Results Based on the results of CMRI-LGE and EMB all patients were divided into 3 groups: 1st – 20 patients (70% male, median age 56 (48.5; 58.5)) with acute inflammatory (more then 14 leucocytes per mm2) and myocardial fibrosis (detecting by EMB and/or CMRI-LGE); 2nd group – 20 patients (65% male, median age 37 (28.0; 49.5)) with myocardial fibrosis without inflammatory changes; 3rd group – 6 patients without fibrosis or inflammatory. In the 1st group fQRS were detected in 7 (35%) patients, ERP – 6 (30%). In the 2nd group fQRS were detected in 5 (25%) patients, ERP – 6 (0%). In the 3rd group fQRS were not detected in 7 (35%) patients, ERP – 6 (30%). We assessed sensitivity and specificity of fQRS and ERP in detected MF and MI by comparing with CMRI-LGE and EMB (table 1). Sensitivity and specificity ECG patterns Myocardial fibrosis Myocardial inflammatory ECG pattern Method Sensitivity Specificity ECG pattern Method Sensitivity Specificity FQRS EMB 76.9% 39.4% FQRS EMB 53.8% 63.6% MRI 83.3% 56.0% MRI 30.8% 84.0% ERP EMB 42.9% 30.8% ERP EMB 85.7% 66.7% MRI 50.0% 41.9% MRI 33.3% 81.3% FQRS, fragmented QRS; ERP, early repolarization pattern; EMB, endomyocardial biopsy; MRI, cardiac magnetic resonance with late gadolinium enhancement. Conclusions FQRS have significant sensitivity (83.3%) and specificity (56%) for detecting MF. And ERP has significant sensitivity (85.7%) and specificity (66.7%) for detecting MI. This ECG patterns could be discussed as screening markers of structural myocardial abnormalities.