Predictive value of a fragmented QRS complex in diagnosing patients with myocardial ischemia

The relationship between fragmented QRS and mortality in without reversible defects patients with scintigraphical myocardial infarction diagnosis

Background/Aim: Evidence of increased mortality in perfusion abnormalities on myocardial perfusion scintigraphy (MPS) can be found. However, electrocardiography (ECG) is a cheaper and more easily accessible examination than MPS. Fragmented QRS (fQRS) is also considered to be associated with mortality in some cardiological diseases. The present study aimed to analyze the relationship between fQRS based on electrocardiography (ECG) and mortality in patients without reversible defects whose fixed hypoperfusion/perfusion defects were diagnosed and associated with myocardial infarction (MI) based on myocardial perfusion scintigraphy (MPS). Methods: Non-ischemic patients (2289 patients) with MI diagnoses based on scintigraphy were selected based on retrospective scintigraphy reports. The presence of fQRS was investigated in 85 patients whose 12-lead electrocardiographs could be accessed from the hospital archive, and their deaths due to all causes were questioned from the death information system. The relationship between left ventricular ejection fraction (LVEF), fQRS, type of exercise, number of leukocytes, other parameters, and mortality rates was analyzed. Results: The numbers of living (n = 69) and deceased (n = 16) patients were obtained. They were divided into two groups: (1) surviving patients (n = 69, number of fQRS positive 42) and (2) deceased (n = 16, number of fQRS positive 11). No distributional differences were found between mortality rates and fQRS and demographic features between groups (P = 0.558). However, a statistically significant effect was observed between mortality rates and low LVEF levels, pharmacological stress, number of leukocytes, and a low HDL level. Conclusion: The present study suggests that it may be useful to define benign features of fQRS. LVEF levels may be a very important parameter in decision-making for pharmacological stress, and its role in prediction of mortality may be higher than that obtained by fQRS.

Fragmented QRS predicted major adverse cardiovascular events in patients with coronary artery disease and percutaneous coronary intervention, 10-years of follow-up

Aim    Identifying high-risk groups in patient with coronary artery disease (CAD) is critical for predicting future adverse events. fQRS has been shown to be related to major cardiovascular adverse events (MACE) in patients with CAD. However, predictive value of fQRS for more than 5 yrs has not been evaluated. This study examined the predictive value of fQRS in patients with CAD and percutaneous coronary intervention during a 10‑yrs period.Material and methods    Patients with CAD and percutaneous coronary intervention between March 2007 and May 2009 were included the study. An electrocardiogram was recorded following percutaneous coronary intervention and analyzed for the presence of fQRS. The fQRS pattern was defined as an additional spike inside the QRS complexes of at least two consecutive leads. Patients were followed for 10 yrs. A MACE was all-cause mortality or new-onset decompensated heart failure. Patients were divided into two groups according to presence or absence of MACE, and their clinical variables were compared.Results    Of 1261 patients included in the study, MACE developed in 374 (29.6 %). MACE (+) patients were older (p<0.001), more likely to have diabetes mellitus (p=0.003), fQRS (p<0.001), and ST-elevated myocardial infarction (STEMI) (p<0.001). Multivariable Cox regression analysis revealed that age (p<0.001), STEMI (p=0.001), fQRS (p=0.017), and elevated serum creatinine (p=0.001) were independent predictors of MACE.Conclusion    The presence of fQRS predicted MACE during 10 yrs of follow-up of patients with CAD and percutaneous coronary intervention.

Predicting efficacy of combined assessment with fragmented QRS and severely depressed heart rate variability on outcome of patients with acute myocardial infarction

The association between fragmented QRS (fQRS) and autonomic nervous dysfunction, and major adverse cardiovascular events (MACE) is not fully clear in patients with acute myocardial infarction (AMI). This study aimed to observe whether combined assessment with fQRS and cardiac autonomic nervous function could enhance the predicting efficacy on outcome in AMI patients. A total of 153 consecutive hospitalized AMI patients were included in this retrospective study. Patients were divided into non-fQRS (nfQRS) group and fQRS group according to 12-lead electrocardiogram, into sHRV [severely depressed heart rate variability (HRV): standard deviation of NN intervals (SDNN) < 100 ms and very low frequency (VLF) < 26.7 ms] group and nsHRV (non-severely depressed HRV) group according to 24 h Holter monitoring, and into non-MACE (nMACE) group and MACE group according to 12 months’ follow-up results. The incidence of sHRV was significantly higher in the fQRS group than in the nfQRS group (71.9 vs. 39.3%, p < 0.05). The incidences of MACE were 7.4, 22.2, 25.7 and 56.5%, respectively, in nsHRV + nfQRS group, nsHRV + fQRS group, sHRV + nfQRS group and sHRV + fQRS group (p < 0.05). Multivariable Cox regression analysis showed that patients in the sHRV + fQRS group had a sixfold higher risk of MACE compared to patients in the nsHRV + nfQRS group (HR = 6.228, 95% CI 1.849–20.984, p = 0.003). The predicting sensitivity and specificity on MACE were 81.4 and 58.2% by sHRV, 69.8 and 69.1% by fQRS in these AMI patients. The specificity (81.8%) was the highest with the combination of sHRV and fQRS. Adding sHRV and fQRS to clinical data offered incremental prognostic value. Present results indicate that fQRS is closely related to sHRV, suggesting significant impairment of sympathetic nerve function in AMI patients with fQRS. Combined assessment with fQRS and sHRV enhances the predicting efficacy on outcome in AMI patients.

Retrospective analysis of time limit of QRS complex in the electrocardiogram and its clinical significance in patients with acute myocardial infarction

OBJECTIVE

This study aimed to analyze the prognostic value of fragmented wide QRS (f WQRS) in patients with acute ST-segment elevation myocardial infarction (STEMI).

METHODS

Eighty-five STEMI patients treated in our hospital from September, 2016 to August, 2017 were selected as objects of study. The patients were divided into Group A (GA, n=15), Group B (GB, n=12), Group C (GC, n=12), Group D (GD, n=16), Group E (GE, n=11) and Group F (GF, n=19) according to results of the electrocardiogram (ECG). The six groups were detected and analyzed with respect to coronary artery lesions, invasion site, cardiac parameters, myocardial injure markers, Killip grading, and prognosis.

RESULTS

GA and GB had right coronary artery occlusion; GC mainly had right coronary artery occlusion and circumflex artery occlusion, and GD mainly had right coronary artery occlusion. The invasion site of GE was mainly in the proximal (middle) segment of anterior descending branch and that of GF in the (middle) distal segment of the anterior descending branch.

CONCLUSION

Monitoring the phenomenon of QRS in ECG is an effective method to evaluate the disease condition and prognosis of STEMI patients. Therefore, this method shall be emphasized in clinical practice.

Prognostic value of fragmented QRS complex in patients with acute myocardial infarction

BACKGROUND

Several factors and risk stratification tools have been studied to determine the prognosis of acute coronary syndrome. Fragmented QRS (fQRS) is a marker of myocardial scar and its prognostic role has recently been demonstrated. The present study aimed to investigate the association between the presence of fQRS in electrocardiogram and the prognosis of ST-segment elevation and non-ST-segment elevation myocardial infarction (STEMI and NSTEMI).

METHODS

A total of 661 patients with myocardial infarction (MI) were enrolled in a retrospective study. Based on the presence of fQRS in admission electrocardiogram, patients were divided into two groups. All patients were followed up for 6 months, and all major adverse cardiovascular events (MACE) were recorded.

RESULTS

The mean age of patients was 61.3 ± 1.2 years, and 71.7% were male. In the acute phase, the detection rates of regional wall motion abnormality and aortic valve insufficiency were higher in positive fQRS compared to negative fQRS group (p = 0.003). The incidence of total MACE was significantly higher in the positive fQRS compared to the negative fQRS group among all patients and in both STEMI and NSTEMI subgroups (p < 0.001). Based on multivariate analysis, the presence of fQRS and hypertension were the strongest predictors of total MACE at 6‑month follow-up (odds ratio [OR] = 5.929; 95% confidence interval [CI] = 3.620-9.709; p < 0.001 and OR = 2.220; 95% CI = 1.390-3.547; p < 0.001, respectively).

CONCLUSION

Regardless of the type of MI, it was found that the presence of fQRS on admission electrocardiogram can be implemented in risk stratification tools in patients with acute MI.

Relationship between fragmented QRS complexes and ejection fraction recovery in anterior ST-segment elevation myocardial infarction patients undergoing thrombolytic treatment

BACKGROUND

Acute anterior ST-segment elevation myocardial infarction (STEMI) is a life-threatening disease. Adverse cardiac events of acute anterior STEMI include cardiovascular death or worsening congestive heart failure. This study investigated the role of fragmented QRS complex (fQRS) in predicting insufficient ejection fraction (EF) recovery in acute anterior STEMI.

METHODS

Patients with acute anterior STEMI who received thrombolytic therapy were prospectively enrolled in this study. Twelve-lead electrocardiography (ECG) was obtained from all patients during admission and 24 and 48 h after admission. We divided the patients into two groups according to the presence of fQRS appearance within 48 h: absence of fQRS in any lead (fQRS-), and its presence in two or more contiguous leads (fQRS+). All patients were evaluated with transthoracic echocardiography at admission, and at follow-up 6 and 12 months later.

RESULTS

A total of 138 consecutive patients were included in the study. Seventy-three patients (52.9%) had fQRS in the ECG. EF recovery in the fQRS(+) group was significantly lower than that of the fQRS(-) group (39% vs. 43.9%, P < 0.001). Multiple logistic regression analysis showed that the fQRS (odds ratio: 4.147, 95% confidence interval: 1.607-10.697, P = 0.003) were an independent predictor of poor EF recovery.

CONCLUSION

The presence of fQRS is an independent predictor for inadequate EF recovery in acute anterior STEMI patients undergoing thrombolytic treatment. Assessment of fQRS on surface ECG may be used in determining high-risk patients for poor EF recovery after acute anterior STEMI.

Predictive value of a fragmented QRS complex in diagnosing patients with myocardial ischemia

Background

A fragmented QRS complex (fQRS) is caused by conduction abnormalities of the ventricle secondary to myocardial ischemia and/or scar in patients with myocardial infarction. However, the implications of the fQRS in the development of coronary artery disease with myocardial ischemia in those without a scar remain unknown.

Methods

We studied electrocardiograms (ECGs) obtained from 150 patients (60.5 ± 8.5 years, 102 men) with myocardial ischemia, which was confirmed by performing both, a nuclear exercise stress test and coronary angiography. We also studied ECGs obtained from 601 patients (58.5 ± 10.0 years, 315 men) who showed a negative nuclear exercise stress test (control group). Patients in whom the nuclear exercise stress test showed a myocardial scar were excluded.

Results

An fQRS was more commonly observed in patients with myocardial ischemia (n = 48, 32.0%) than in the control group (n = 133, 22.1%) (P = 0.011). The sensitivity, specificity, positive, and negative predictive values of fQRS in diagnosing myocardial ischemia were 32.0, 77.9, 26.5, and 82.1%, respectively. The fQRS (odds ratio 1.580, 95% confidence interval 1.020‐2.446, P = 0.040) was an independent predictor of myocardial ischemia after adjusting for age, sex, current smoking habits, ST‐T changes on ECG, as well as histories of hypertension, diabetes, and dyslipidemia. Moreover, the fQRS showed an incremental prognostic value over conventional risk factors (χ² = 5, P = 0.032) and over a combination of conventional factors and ST‐T changes (χ² = 9, P = 0.014).

Conclusions

The fQRS is a moderately sensitive and independent predictor of myocardial ischemia.