Presence Of fQRS Research Articles

Major depressive disorder is associated with fragmented QRS

Objective There is a close link between major depressive disorder (MDD) and cardiovascular disease (CVD). Increasing oxidative stress, changes in hypothalamic-pituitary-adrenal axis and platelet clotting cascade may lead to subclinical myocardial damage in MDD patients without overt CVD. The aim of the study was to investigate whether MDD is associated with fragmented QRS (fQRS) on electrocardiogram (ECG) which may reflect myocardial fibrosis/scarring and ischaemia.Methods and results A total of 66 MDD patients without overt CVD and 35 age- and sex-matched control subjects were enrolled in this study. Twelve-lead surface ECGs were analysed for the presence of fQRS and echocardiographic examination was performed for each individual. Multivariate logistic regression analysis was used to assess the relationship between MDD and fQRS. The baseline characteristics in terms of age, gender, body mass index and cardiovascular risk factors were comparable in the groups (all P values >0.05). Left ventricular ejection fraction, left ventricular wall thickness and diastolic blood pressure were also similar in the two groups. The presence of fQRS was more prevalent (P < 0.001) and SBP values (P = 0.007) were higher in patients with MDD compared to controls. Moreover, multivariate binary logistic regression analysis indicated the recurrent MDD as the only independent predictor of fQRS on ECG (beta =0.196, 95% CI 0.046 - 0.827, P = 0.014).Conclusion The presence of fQRS on the ECG is associated with MDD, and may be a beneficial tool for detecting subclinical cardiac damage in this population.

Appearance of QRS fragmentation late after Mustard/Senning repair is associated with adverse outcome

ObjectiveTo evaluate if development of fragmented QRS (fQRS) complexes, a marker of inhomogeneous ventricular activation due to myocardial fibrosis, is associated with adverse outcome in adults after Mustard/Senning repair for...

Comparison of the presence of fragmented QRS complexes in the inferior versus the anterior leads for predicting coronary artery disease severity

IntroductionFragmented QRS complexes (fQRS) are a sign of myocardial scar and are associated with adverse outcomes and mortality in patients with coronary artery disease (CAD). However, little is known about the significance of fQRS or of their localization on electrocardiography (ECG) in patients without known CAD. We aimed to investigate the association between localization of fQRS on ECG and CAD severity in patients undergoing a first diagnostic coronary angiography. MethodsWe enrolled 135 consecutive patients who had a narrow fQRS on ECG and underwent a first diagnostic coronary angiography. Patients were divided into two groups based on localization of fQRS on ECG (group 1: fQRS in the inferior leads, group 2: fQRS in the anterior leads). The groups were compared regarding the presence of significant CAD, multivessel disease (MVD) and SYNTAX score (SXscore). ResultsEighty-six (63.7%) patients had fQRS in the inferior leads and 49 (36.3%) had fQRS in the anterior leads. There was no statistically significant difference between the groups regarding presence of significant CAD (47.7% vs. 51%, p=0.708). However, the incidence of MVD was significantly higher in group 2 compared to group 1 (10.5% vs. 28.6%, p=0.007). The median SXscore (6 [3,12] vs. 8 [4,24], p=0.047), and incidence of patients with SXscore >22 were significantly higher in group 2 compared to group 1 (3.5% vs. 20.4%, p=0.009). ConclusionThe presence of fQRS in the anterior leads may indicate more severe CAD compared to fQRS in the inferior leads in patients undergoing a first diagnostic coronary angiography.

Comparison of the presence of fragmented QRS complexes in the inferior versus the anterior leads for predicting coronary artery disease severity

IntroductionFragmented QRS complexes (fQRS) are a sign of myocardial scar and are associated with adverse outcomes and mortality in patients with coronary artery disease (CAD). However, little is known about the significance of fQRS or of their localization on electrocardiography (ECG) in patients without known CAD. We aimed to investigate the association between localization of fQRS on ECG and CAD severity in patients undergoing a first diagnostic coronary angiography. MethodsWe enrolled 135 consecutive patients who had a narrow fQRS on ECG and underwent a first diagnostic coronary angiography. Patients were divided into two groups based on localization of fQRS on ECG (group 1: fQRS in the inferior leads, group 2: fQRS in the anterior leads). The groups were compared regarding the presence of significant CAD, multivessel disease (MVD) and SYNTAX score (SXscore). ResultsEighty-six (63.7%) patients had fQRS in the inferior leads and 49 (36.3%) had fQRS in the anterior leads. There was no statistically significant difference between the groups regarding presence of significant CAD (47.7% vs. 51%, p=0.708). However, the incidence of MVD was significantly higher in group 2 compared to group 1 (10.5% vs. 28.6%, p=0.007). The median SXscore (6 [3,12] vs. 8 [4,24], p=0.047), and incidence of patients with SXscore >22 were significantly higher in group 2 compared to group 1 (3.5% vs. 20.4%, p=0.009). ConclusionThe presence of fQRS in the anterior leads may indicate more severe CAD compared to fQRS in the inferior leads in patients undergoing a first diagnostic coronary angiography.

The relationship between fragmented QRS and functional significance of coronary lesions

BackgroundRecently fragmented QRS (fQRS) on electrocardiography (ECG) has been introduced as a predictor of myocardial scarring and myocardial ischemia in coronary artery disease (CAD). ObjectiveThe aim of this study was to investigate the relationship between fQRS and fractional flow reserve (FFR) results in patients with the intermediate degree of coronary artery stenosis. MethodsA total of 301 consecutive patients who underwent coronary angiography (CAG) and FFR measurement for intermediate coronary artery stenosis were included in the study. The study patients were divided into two groups: the low FFR group (FFR value of ≤0.80) and normal FFR (FFR value of >0.80) group. Both groups were compared in terms of the presence of fQRS. ResultsOf 301 patients, fQRS was detected in 128 (42.5%) and low FFR was detected in 115 (38.2%). In the low FFR group, fQRS was significantly higher (P<0.001). Multivariate analysis showed that fQRS was an independent predictor of myocardial ischemia in patients with intermediate coronary stenosis (OR=7.202, CI 95%, 4.195–12.367; p<0.001). The presence of fQRS had 70% sensitivity and 74% specificity for the prediction of FFR≤0.80. ConclusionIn clinical practice, the presence of fQRS on ECG is associated with myocardial ischemia in patients with intermediate coronary stenosis.

Relationship between fragmented QRS complexes in leads V4-V6 and left ventricular apical thrombus formation in patients presenting with first acute anterior myocardial infarction.

The present study was an investigation of the relationship between fragmented QRS (fQRS) and left ventricular apical thrombus (LVAT) in patients presenting with first acute anterior myocardial infarction (MI). Consecutive 148 patients (mean age: 60.1±10.1 years; male: 75.6%) with first acute anterior MI who underwent primary percutaneous coronary intervention (PCI) were included. Study population was divided into 2 groups based on presence of LVAT. fQRS was defined as presence of various RSR' patterns, which included additional R wave or notching of R wave or S wave, and presence of more than 1 R in 2 contiguous leads corresponding to major coronary artery territory on 12-lead electrocardiogram. Patients with bundle branch block were excluded from the study. Of these, 32 (21.6%) had LVAT. Patients with LVAT had higher prevalence of fQRS (53.1% vs. 22.4%; p<0.001) and lower rate of successful PCI (75% vs. 94%; p=0.002) compared with patients without LVAT. More patients in LVAT group had left ventricular ejection fraction of <30% (87.5% vs 65.5%; p=0.010). Groups were similar with respect to other baseline characteristics (p>0.05 for all). Presence of fQRS was independent predictor of LVAT (odds ratio [OR], 2.795; 95% confidence interval [CI], 1.058-7.396) in multivariable logistic regression analysis. Presence of fQRS in leads V4-V6 is independently associated with LVAT in patients presenting with first acute anterior MI.

Abstract 13427: The Presence of Fragmented QRS predicts Mortality and Appropriate Shocks in ICD Recipients

Introduction: QRS fragmentation (fQRS) on the 12-lead electrocardiogram (ECG) has been shown to reflect inhomogeneous activation of the ventricles by the presence of myocardial infarction or scarring. Presence of fQRS has been shown to be a predictor of mortality and sudden cardiac death, however data in ICD recipients are scarce. Methods: All ICD recipients in our hospital with ischemic (ICM) or non-ischemic cardiomyopathy were included in this single-center retrospective registry. Electrocardiograms before implant were analyzed for the presence of fQRS according to the criteria defined by Das in 2006 and 2008. Endpoints were appropriate ICD shocks (AS) and all-cause mortality. Kaplan-Meier and multivariate Cox regression analyses with demographic, clinical and electrocardiographic variables were performed. Results: A total of 727 patients (84.9% male, 66.4% ICM, 56% primary prevention) with a mean follow-up of 5.2±4.1 y were included. Annual mortality rate was 3.9%/y and for shocks 9.4%/y. Overall 50.6% of patients had fQRS on the ECG, most frequently localized in the inferior (35.4%), followed by the anterior (21.6%) and lateral leads (11.1%). The presence of fQRS in any region was an independent predictor of mortality (HR 1.535, 95%CI 1.141-2.066), particularly in primary prevention patients (HR 1.927, 95%CI 1.206-3.079). Overall fQRS was not an independent predictor of AS. fQRS in the anterior leads was an independent predictor of mortality (HR 1.550, 95%CI 1.130-2.125), particularly in primary prevention patients (HR 2.625, 95%CI 1.575-4.377). Further, in primary prevention anterior fQRS showed a trend towards independent prediction of AS (p=0.059, HR 1.573, 95%CI 0.984-2.514). The presence of fQRS in the lateral leads was an independent predictor of mortality in primary prevention patients (HR 2.037, 95%CI 1.088-3.814), not in the overall study population. Presence of fQRS in the inferior leads did not show any significant results analyzing the complete follow-up. Conclusions: Presence of fQRS on the ECG before ICD implantation could be used as risk stratification tool identifying patients at increased risk of dying, particularly if present in the anterolateral leads and in patients with primary prevention ICD indications.

Usefulness of Fragmented QRS Complexes in Patients With Congenital Heart Disease to Predict Ventricular Tachyarrhythmias

Fragmented QRS complexes (fQRS) on 12-lead electrocardiogram are known predictors of ventricular tachyarrhythmia (VTA) in patients with coronary artery disease. There is limited knowledge of the clinical implications of fQRS in patients with congenital heart defects (CHD). Aims of this study were to examine (1) the occurrence of fQRS in patients with various types of CHD and (2) whether fQRS is associated with development of VTA. This study was designed as retrospective case-control study. Patients with CHD with VTA were included and matched with control patients of the same age, gender, and CHD type. Clinical data and fQRS were analyzed and compared. The initial VTA episode developed in 139 patients with CHD at a mean age of 39 ± 14years. Compared with controls (n= 219, age 38 ± 13years), QRS duration was longer in patients with VTA (110 vs 100ms; p <0.01). Furthermore, fQRS was more frequently observed in patients with VTA in the last electrocardiogram before VTA (n= 73 [53%] vs n= 67 [31%]; p <0.001), especially in patients with sustained VTA (64%). Multiple conditional logistic regression demonstrated more fQRS (odds ratio [OR] 2.9, 95% confidence interval [CI] 1.5 to 5.8; p= 0.002), nonsystemic ventricular dysfunction (OR 5.1, 95% CI 2.1 to 12.4; p <0.001), and more prolonged QRS complexes (OR 2.8, 95% CI 1.3 to 6.2; p= 0.011) in patients with VTA. Therefore, the presence of fQRS on electrocardiogram may be a useful tool in daily clinical practice to identify patients at risk for developing VTA in patients with CHD, in addition to known predictors of VTA.

218-06: Fragmented QRS is Associated with an Increased Risk of Ventricular Tachycardia Recurrence and Cardiac Death after Catheter Ablation in Ischemic Heart Disease

Background: Fragmented QRS (fQRS) has been associated with cardiac death and ventricular arrhythmias in patients (pts) with myocardial infarction. However, the clinical impact of fQRS on recurrent ventricular tachycardia (VT) and cardiac death after radiofrequency catheter ablation (RFCA) in post-infarct pts is unknown. Method: We retrospectively included 160 pts (68 ± 9 years; 138 men; left ventricular ejection fraction 33 ± 12%) who underwent RFCA of post-infarct VT from 2009 to 2015. Pre-procedural 12 lead ECGs were evaluated for fQRS defined as RSR' patterns (>1 R' or notching of R or S wave) in pts with a narrow QRS complex and >2 notches of R or S wave in pts with wide QRS complex, present in ≥2 contiguous leads. The primary endpoint was freedom from any VT recurrence and cardiac death after RFCA. Result: Among 160 pts, fQRS was present in 37 (23%) pts; anterior leads in 20 pts, lateral in 9 pts, inferior in 19 pts. Pts were inducible for 3 (interquartile range [IQR] 2–5) VTs. Procedural success (non-inducibility of any VT) was achieved in 74 pts. During follow-up of 17 (IQR 9–24) months, 44 (34%) pts experienced the primary end point. The presence of fQRS was associated with an increased risk of VT recurrence and cardiac death (P = 0.006 by log-rank test). The significant difference was driven by VT recurrence (p = 0.002) but not by cardiac death (p = 0.361). Considering specific locations only fQRS in anterior leads was associated with the primary endpoint (p = 0.005); not in inferior and lateral leads (p = 0.145 and p = 0.84, respectively). A multivariable Cox regression analysis revealed that the presence of fQRS (hazard ratio [HR] 2.27; 95% CI 1.23–4.21; p = 0.009), left ventricular ejection fraction less than 30% (HR 2.36; 95% CI 1.24–4.48; p = 0.009), and number of induced VT during RFCA (HR 1.25; 95% CI 1.12–1.39; p < 0.001) were independent predictors for the endpoint. Conclusion: An fQRS predicts VT recurrence and cardiac death after RFCA of post-infarct VT.

136-47: Fragmented QRS and mortality risk in patients with left ventricular dysfunction

Background: Fragmented QRS (fQRS) has been shown to predict cardiac events in select patient populations. Whether fQRS improves patient selection for primary prevention patients eligible for implantable cardioverter-defibrillator (ICD) therapy remains unknown. Methods: It was a prospective study including 142 patients with left ventricular dysfunction (ejection fraction < or =35%) representing both ischemic and nonischemic etiology. the presence of fQRS on ECG was assessed using standardized criteria. The association between fQRS and all-cause and arrhythmic mortality was evaluated overall and stratified by ICD status using multivariable Cox regression models, adjusted for demographic, clinical, and treatment variables. Results: Fragmented QRS was present in 46 (32.4%) patients, and there were 32 (22.5%) deaths during a mean follow-up of 10 + /-7 months. Rates of all-cause mortality did not differ between the fQRS+ (18.4%) and fQRS- (23%) groups; adjusted hazard ratio, 0.88; 95% confidence interval, 0.63–1.22; P = 0.43. Additionally, rates of arrhythmic mortality were similar between the fQRS+ (8.7%) and fQRS- (10.7%) groups: adjusted hazard ratio, 0.77; 95% confidence interval, 0.49–1.31; P = 0.38. Subgroup analyses found no association between fQRS and mortality when the study was further stratified by ICD status, etiology of left ventricular dysfunction, wide (>/ = 120 ms) versus narrow (<120 ms) QRS duration, or fQRS myocardial territory. Conclusions: In this prospective study of patients with left ventricular dysfunction, the presence of fQRS on ECG was not associated with a higher risk of either all-cause or arrhythmic mortality. These findings do not provide evidence that fQRS would be effective in risk stratifying primary prevention patients eligible for ICD therapy.

97-06: Fragmented QRS is Not Associated with Conduction Delay and Ventricular Arrhythmias in Patients with Repaired Tetralogy of Fallot

Introduction: Fragmented QRS complexes (fQRS) on 12-lead ECG may reflect conduction delay due to myocardial scarring and have been associated with ventricular tachyarrhythmia (VT) in patients with ischemic and nonischemic cardiomyopathy. Non-invasive risk stratification for VT in patients with repaired TOF (rTOF) has limited predictive value. This study evaluates the potential electroanatomical substrate underlying fQRS and the value of fQRS for VT risk stratification in rTOF. Methods: Fifty-three rTOF patients (46 ± 16 yrs, 64% male) at risk for VT (n = 42) or with documented VT (n = 11) underwent VT induction and detailed RV electroanatomical voltage and activation mapping (EAM) during SR to evaluate total RV activation time (RVAT) and areas of local conduction delay. Routine 12-lead ECGs prior to EAM were assessed for QRS duration, bundle branch block and fQRS defined as RSR' patterns (>1 R' or notching of R or S wave) in patients with a narrow QRS complex or >2 notches in R or S wave in patients with a wide QRS complex, present in ≥2 contiguous leads. Presence of fQRS, local conduction delay (<0.5m/s) and RVAT were compared between patients with and without spontaneous and/or induced VT. Results: Mean QRSd was 156 ± 33ms; 7 patients had narrow QRS, 46 broad QRS (24 RBBB, 7 RBBB + LAFB, 9 LBBB, 6 other). RVAT was 126 ± 37ms. Localized conduction delay confined to anatomical isthmuses was observed in 23 pts. Twenty-four patients were inducible for 37 VTs, including all with prior documented VT. Thirty-three of 37 VTs could be mapped to a slow conducting anatomical isthmus (SCAI).FQRS was present in 19 (36%) patients (3 narrow, 16 wide QRS complex) and did not differ significantly between patients with and without VT (8/24 versus 11/29 patients respectively, p = 0.728). FQRS was not associated with longer RVAT (131 ± 46ms in patients with fQRS versus 122 ± 32ms without fQRS; p = 0.402) and was not related to the presence of SCAI (SCAI present in 7 patients with fQRS versus 15 patients without fQRS p = 0.857). Conclusion: Fragmented QRS is a frequent finding and not associated with conduction delay and VA in patients with rTOF. It may be due to changes in wavefront propagation as a consequence of the surgical intervention.

Prognostic Value of QRS Fragmentation in Patients with Acute Myocardial Infarction: A Meta-Analysis.

Fragmented QRS has emerged as a novel electrocardiographic parameter associated with adverse clinical events in various diseases. The aim of this study was to investigate the association of fQRS with in-hospital and long-term cardiovascular events in patients with ST-segment elevation myocardial infarction (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI). We searched PubMed, Embase, Web of Science, and Cochrane Library up to October 2015 for eligible studies. We selected studies with fQRS defined with 12-lead ECG during the index hospitalization of STEMI/NSTEMI. Primary outcomes were in-hospital and long-term cardiovascular events. In-hospital mortality was significantly higher in fQRS (+) group (99/733; 13.5%) compared to fQRS (-) group (47/1293; 3.6%) (OR 4.03 95% CI 1.81-8.94; P = 0.0006). Long-term mortality rate was higher in fQRS (+) group (89/473; 18.8%) compared to fQRS (-) group (54/1009; 5.3%) (OR 3.93 95% CI 1.92-8.05; P = 0.0002). In addition the frequency of long-term MACE was higher in fQRS (+) group (46.9%) compared to fQRS (-) group (14.6%) (OR 5.13 95% CI 2.77-9.51; P < 0.00001) CONCLUSION: Presence of fQRS on admission ECG was found to be predictor of mortality, MACE, deterioration of LV function, and presence of multivessel disease in patients with STEMI and NSTEMI.

Usefulness of Fragmented QRS Complex to Predict Arrhythmic Events and Cardiovascular Mortality in Patients With Noncompaction Cardiomyopathy

We aimed to evaluate the prevalence and prognostic role of fragmented QRS complex (fQRS) in predicting arrhythmic events and cardiovascular mortality in patients with noncompaction cardiomyopathy (NCC). A total of 88 patients (64.8% men, mean age 38.6 ± 17.7 years) with the diagnosis of NCC were enrolled. Median follow-up time was 42.4 months. The fQRS was defined as the presence of ≥1 additional R wave (R') or notch on the R/S waves in ≥2 contiguous leads representing anterior (V1 to V5), inferior (II, III, and aVF), or lateral (I, aVL, and V6) myocardial segments. Compared to patients without fQRS group, patients with fQRS (fQRS (+) group) showed higher rates for total arrhythmic events, ventricular tachycardia, bradyarrhythmia requiring pacemaker, sudden cardiac death, cardiovascular mortality, and all-cause mortality. The cut-off point of ≥3 leads for the fQRS was the optimal point discriminating an arrhythmic event and cardiovascular mortality. In Kaplan-Meier survival analysis, total arrhythmic events and cardiovascular mortality occurred more frequently in the fQRS (+) group. In multivariate Cox proportional hazard regression analysis, after adjusting for other confounding factors, the presence of fQRS were found to be as an independent predictor of arrhythmic events (hazard ratio 3.850, 95% CI 1.062 to 9.947, p = 0.002) and cardiovascular mortality (hazard ratio 2.719, 95% CI 1.494 to 9.262, p = 0.005). In conclusion, the presence of fQRS complex, as a simple and feasible electrocardiographic marker, seems to be a novel predictor of arrhythmic events and cardiovascular mortality in patients with NCC. This simple parameter may be used in identifying patients at high risk for arrhythmic events and so individualization of specific therapies can be applied.

Fragmented QRS complexes are a marker of myocardial fibrosis in hypertensive heart disease.

Carboxy-terminal propeptide of type 1 procollagen (PICP) is a marker of extracellular collagen synthesis. Fragmented QRS (fQRS) on a 12-lead electrocardiogram (ECG) has been demonstrated as a marker of myocardial fibrosis. The present objective was to investigate the association between serum PICP concentration and presence of fQRS on ECG in hypertensive patients. Consecutive patients with previously or newly diagnosed hypertension were included. fQRS was defined as the presence of additional R-wave (R'), or notching of R- or S-waves, or the presence of fragmentation in 2 contiguous ECG leads. Serum PICP levels were measured by ELISA method. The study group consisted of 90 hypertensive patients (74% females, with a mean age of 54.7±8.5 years). Of these patients, 47 (52.2%) had fQRS on ECG. Age (p=0.121) and gender distribution (p=0.625) were similar in patients with or without fQRS. Receiver operating characteristic curve analysis yielded a strong predictive ability of PICP levels for the presence of fQRS (area under the curve: 0.850; 95% CI: 0.772-0.929; p<0.0001). In multivariate logistic regression analysis, PICP levels were strongly and independently associated with the presence of fQRS (OR: 1.938; 95% CI: 1.398-2.688). Serum PICP level is a strong and independent predictor of fQRS. Discriminative performance of serum PICP levels for the presence of fQRS is high. The present results are the first to demonstrate that fQRS may indicate myocardial fibrosis in patients with hypertension.

Fragmented QRS complexes are associated with left ventricular systolic and diastolic dysfunctions in patients with metabolic syndrome.

Metabolic syndrome (MetS) is found to be associated with deterioration of the left ventricular (LV) systolic and diastolic functions. One of the factors for this impairment is myocardial fibrosis. Fragmented QRS (fQRS) complexes are found to be associated with myocardial fibrosis. The aim of the study was to evaluate if the presence of fQRS on electrocardiogram (ECG) can detect pronounced impairment in the LV systolic and diastolic functions in MetS patients. The study included 111 (mean age 47 ± 9, 49.5% male) MetS patients and 96 (mean age 45 ± 9, 58.3% male) control subjects without MetS. ECG was evaluated for the presence of fQRS. Each patient underwent conventional echocardiography and tissue Doppler imaging. Fragmented QRS was more common among MetS patients (26.1% vs. 14.6%, p = 0.041). MetS was associated with subclinical LV systolic and LV diastolic dysfunctions. In subgroup analyses of MetS patients, the presence of fQRS on ECG had a higher E/E' ratio and lower E' velocity, indicating pronounced diastolic dysfunction, as well as lower isovolumic acceleration(IVA), indicating profound subclinical LV systolic dysfunction. E/E' ratio and IVA were independent predictors of fQRS presence in patients with MetS. Fragmented QRS is more common among MetS patients compared to non-MetS patients. The presence of fQRS is associated with pronounced subclinical LV systolic and diastolic dysfunctions in MetS patients.

Fragmentation of the QRS complex in patients with acute coronary syndrome treated invasively

Previous studies showed that the presence of fragmented QRS (f-QRS) in patients with acute coronary syndrome (ACS), who underwent complete revascularisation, is associated with worse prognosis and the possibility of arrhythmia occurrence. To assess the prognostic value of f-QRS in patients with ACS and complete revascularisation, in the context of cardiac ar-rhythmias. We analysed 124 consecutive patients (66.1% males; mean age 62.38 ± 11.0 years) with ACS (STEMI 49%) treated invasively. Based on electrocardiogram (ECG) record, performed during the admission to the clinic, after the complete revascularisation (TIMI = 3) and during discharging from hospital (4th-5th days after ACS), we classified QRS as f-QRS based on generally accepted criteria (QRS < 120 ms, which included an additional R wave [R']) or notching in the nadir of the S wave, or > 1 R' (fragmentation) in two contiguous leads, corresponding to a major coronary artery territory. 24-h Holter ECG recording was performed on the fifth day after ACS to assess the frequency of conduction disturbances and others arrhythmias. There were no statistically significant differences between patients with and without f-QRS during hospitalisation. In the patients with f-QRS there were no statistically significant conduction disturbances and other arrhythmias compared to patients without f-QRS at discharge. In the patients with ACS, who underwent successful revascularisation (TIMI = 3), the presence of f-QRS is not correlated with a higher incidence of arrhythmias compared to patients without f-QRS in short-term follow-up.

Fragmented QRS Complex Predicts In-Hospital Adverse Events and Long-Term Mortality in Patients with Acute Pulmonary Embolism.

Electrocardiographic (ECG) abnormalities in pulmonary embolism (PE) are increasingly reported, and mounting data have recommended that ECG plays a crucial role in the prognostic assessment of PE patient population. However, there is scarce data on the prognostic importance of fragmented QRS (fQRS) on short- and long-term outcomes in patients with PE. Therefore, we aimed to investigate the prognostic role of fQRS in predicting in-hospital and long-term adverse outcomes in PE patients. A total of 249 patients (155 female, 66.2%; mean age, 66.0 ± 16.0) with the diagnosis of acute PE were enrolled and followed-up during median 24.8 months. Compared with the fQRS (-) patient group, patients with fQRS showed higher rates of in-hospital adverse events including cardiogenic shock, the necessity of thrombolytic therapy, and in-hospital mortality as well as long-term all-cause mortality. In Kaplan-Meier survival analysis, during follow-up, all-cause mortality occurred more frequently in the fQRS (+) group (log-rank, P = 0.002). In multivariate Cox regression analysis, adjusted with other relevant parameters, the presence of fQRS were determined as an independent predictor of in-hospital adverse events (HR: 2.743, 95% CI: 1.267-5.937, P = 0.003) and long-term all-cause mortality (HR: 3.137, 95% CI: 1.824-6.840, P = 0.001). The presence of fQRS complex, as a simple and feasible ECG marker, seems to be a novel predictor of in-hospital adverse events and long-term all-cause mortality in PE patient population. This parameter may utilize the identification of patients whom at higher risk for mortality and individualization of therapy.

The usefulness of fQRS and QRS distortion for predicting reperfusion success and infarct-related artery patency in patients who underwent thrombolytic therapy.

The aim of this study is to determine whether the presence of fragmented QRS (fQRS) and QRS distortion on admission ECG can be used to predict the success of treatment before beginning thrombolytic therapy (TT). Two hundred and three eligible patients with acute ST elevation myocardial infarction who received TT consecutively between 1 January 2009 and 1 July 2013 were enrolled. The presence of fQRS and QRS distortion was analyzed at admission ECG. The electrocardiographic criteria of reperfusion were defined as 50% or more of ST resolution (STR), whereas the angiographic criteria of reperfusion were defined as thrombolysis in myocardial infarction 2/3 flow in the infarct-related artery. fQRS was detected in 63 (31%) patients. Compared with patients with non-fQRS, STR was lower (46.1±17.7 vs. 73.6±20.9, respectively; P<0.001), thrombolysis failure was higher (44.4 vs. 9.3%, respectively; P<0.001), and thrombolysis in myocardial infarction 0/1 flow was more common (39.7 vs. 10.7%, respectively; P<0.001) in patients with fQRS. Higher numbers of fQRS derivations were significantly related to low percentages of STR (r=-0.615, P<0.001). In predicting occluded infarct-related artery, we found no difference between the negative predictive values of fQRS and inadequate STR after TT (89.3 vs. 95.1%; P>0.05). However, there was no relationship between QRS distortion and failed thrombolysis. fQRS was detected in just 31% of the patients, but we found that it can be used to predict thrombolytic failure. Patients who have this simple marker on admission ECG may be directed to percutaneous interventions as a first-line therapy without any delay.

Fragmented QRS frequency in patients with cardiac syndrome X.

Objective:Cardiac syndrome X (CSX) is characterised by typical exertional chest pain, a positive response to exercise testing, and a normal coronary angiography. The relationship of CSX with myocardial fibrosis and ischemia has been clearly demonstrated in previous studies. In addition, fragmented QRS (fQRS) has been reported in the literature as an indicator of myocardial fibrosis. The aim of this study was to investigate the frequency of fQRS in patients with CSX.Methods:This prospective case-control study included 37 patients (CSX group) with typical complaints of angina, ischemia on an exercise test, and normal coronary arteries as detected by angiography and 47 patients (control group) with normal coronary arteries. Echocardiographic examinations were performed according to the recommendations of the American Society of Echocardiography. Continuous variables were expressed as mean±standard deviation (SD), and the qualitative variables were expressed as a percentage or ratio. Data were compared statistically with Shapiro–Wilk test, Student’s t-test, Mann-Whitney U, chi-square and Fisher exact test.Results:There was no significant difference between the CRX and control groups with respect to basic characteristics such as age and sex. fQRS and the frequency of its presentation with stable angina pectoris at the clinic were significantly higher in the CSX group than in the control group (p values: 0.001 and <0.001, respectively).Conclusion:A close follow-up would be useful in CSX patients in whom fQRS is detected in an electrocardiogram (ECG) because of the association between fQRS and poor prognosis with respect to the prevention of late complications. We believe that the presence of fQRS in the ECG aids in the diagnosis of CSX in clinical practice and in the recognition of this group of patients. (Anatol J Cardiol 2016; 16: 616-20)

Fragmented QRS complexes have predictive value of imperfect ST-segment resolution in patients with STEMI after primary percutaneous coronary intervention

ObjectivesTo investigate the clinical characteristics of patients with the fragmented QRS complexes (fQRS) and the predictive value of fQRS in patients undergoing primary percutaneous coronary intervention (p-PCI). MethodsThe study enrolled 227 consecutive patients with ST-elevation myocardial infarction who underwent p-PCI. Baseline clinical characteristics, the percentage of ST-segment resolution, and parameters of electrocardiography and coronary angiography were investigated. The relationship between fQRS on pre-PCI and post-PCI electrocardiogram and the percentage of ST-segment resolution after PCI were studied. ResultsPatients with fQRS have higher troponin I, creatine kinase-MB levels, prolonged QRS duration, higher Gensini score, lower percentage of total ST-segment resolution, and left ventricular ejection fraction compared with patients without fQRS. Gensini score (odds ratio [OR], 1.013; 95% confidence interval [CI], 1.002-1.024; P < .006) and percentage of total ST-segment resolution (OR, 0.384; 95% CI, 0.186-0.795; P = .01) were independently associated with the presence of fQRS. A multivariate logistic regression analysis selected presence of fQRS pre-PCI (OR, 2.908; 95% CI, 1.095-7.723; P = .032) and the number of leads with fQRS before PCI (OR, 1.582; 95% CI, 1.250-2.002; P < .001) as independent predictors of imperfect ST-segment resolution. ConclusionsThe presence of fQRS is a predictor in ST-elevation myocardial infarction patients undergoing p-PCI. The occurrence of fQRS is beneficial to identify the patients with severe coronary lesion, left ventricular contraction dysfunction, and larger areas of ischemic injury.