Abstract
Background: Fragmented QRS (fQRS) represents myocardial conduction abnormalities due to myocardial scar in patients with coronary artery disease. However, the implication of the fQRS has not been known in patients with myocardial ischemia without scar. Methods: Electrocardiograms from 97 patients (59.9±8.7 years; 67 males) with myocardial ischemia which was confirmed by both exercise nuclear stress test and coronary angiography and 169 patients (56.8±10.2 years; 76 males) who had negative results of exercise nuclear stress test (the control group) were studies. Patients with myocardial scar in nuclear stress test were excluded. Results: The fQRS was more frequent in patients with myocardial ischemia (n=35, 36.1%) than in the control group (n=37, 21.5%) (p=0.010). The sensitivity, specificity, positive predictive value, and negative predictive value of fQRS for diagnosing myocardial ischemia were 36.1%, 78.5%, 48.6%, and 68.5%, respectively. The fQRS (Odds ratio 3.41, 95% confidence interval 1.54 to 7.55, p=0.002) was associated with myocardial ischemia after adjusting for age, gender, current smoking, histories of hypertension, diabetes and hyperlipidemia. Conclusion: The fQRS is a moderately sensitive and an independent predictor for prediction of myocardial ischemia. Large studies are needed to evaluate the implication of fQRS in patients with myocardial ischemia without scar.
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