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Chan JSK, Zhou J, Lee S, Li A, Tan M, Leung KSK, Jeevaratnam K, Liu T, Roever L, Liu Y, Tse G, Zhang Q. Fragmented QRS Is Independently Predictive of Long-Term Adverse Clinical Outcomes in Asian Patients Hospitalized for Heart Failure: A Retrospective Cohort Study. Front Cardiovasc Med 2021; 8:738417. [PMID: 34859066 PMCID: PMC8631899 DOI: 10.3389/fcvm.2021.738417] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/22/2021] [Indexed: 12/29/2022] Open
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.
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Affiliation(s)
- Jeffrey Shi Kai Chan
- Cardiovascular Analytics Group, Laboratory of Cardiovascular Physiology, Hong Kong, Hong Kong SAR, China
| | - Jiandong Zhou
- Cardiovascular Analytics Group, Laboratory of Cardiovascular Physiology, Hong Kong, Hong Kong SAR, China.,School of Data Science, City University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Sharen Lee
- Cardiovascular Analytics Group, Laboratory of Cardiovascular Physiology, Hong Kong, Hong Kong SAR, China
| | - Andrew Li
- Cardiovascular Analytics Group, Laboratory of Cardiovascular Physiology, Hong Kong, Hong Kong SAR, China.,Faculty of Science, University of Calgary, Calgary, AB, Canada
| | - Martin Tan
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Keith Sai Kit Leung
- Cardiovascular Analytics Group, Laboratory of Cardiovascular Physiology, Hong Kong, Hong Kong SAR, China.,Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Kamalan Jeevaratnam
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Leonardo Roever
- Departamento de Pesquisa Clinica, Universidade Federal de Uberlandia, Uberlandia, Brazil
| | - Ying Liu
- Heart Failure and Structural Cardiology Division, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Gary Tse
- Cardiovascular Analytics Group, Laboratory of Cardiovascular Physiology, Hong Kong, Hong Kong SAR, China.,Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom.,Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China.,Kent and Medway Medical School, Canterbury, United Kingdom
| | - Qingpeng Zhang
- School of Data Science, City University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Özdemir İH, Özlek B, Özen MB, Gündüz R, Çetin N, Özlek E, Yıldız BS, Tıkız H. Fragmented QRS is a marker of mortality in patients with severe COVID-19: A retrospective observational study. Anatol J Cardiol 2021; 25:811-820. [PMID: 34734815 DOI: 10.5152/anatoljcardiol.2021.62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE In this study, we aimed to investigate the association of fragmented QRS (f-QRS) with in-hospital death in patients with severe novel coronavirus disease 2019 (COVID-19). METHODS This was a retrospective and observational study. A total of 201 consecutive patients with severe COVID-19 were enrolled. Demographic data, laboratory parameters, medications, electrocardiographic (ECG) findings, and clinical outcomes were recorded. Patients with and without f-QRS were compared, and predictors of all-cause in-hospital mortality were analyzed. RESULTS A total of 135 patients without f-QRS (mean age of 64 years, 43% women) and 66 patients with f-QRS (mean age of 66 years, 39% women) were included. C-reactive protein (CRP), D-dimer, troponin I, ferritin levels, and CRP to albumin ratio were significantly higher in patients with f-QRS. The need for invasive mechanical ventilation (63.6% vs. 41.5%, p=0.003) and all-cause in-hospital mortality [54.5% vs. 28.9%, log rank p=0.001, relative risk 1.88, 95% confidence interval (CI) 1.16-4.78] were significantly higher in patients with f-QRS. A number value of f-QRS leads ≥2 yields sensitivity and specificity (85.3% and 86.7%, respectively) for predicting in-hospital all-cause mortality. Multivariable analysis showed that f-QRS (odds ratio: 1.041, 95% Cl: 1.021-1.192, p=0.040) were independently associated with in-hospital death. CONCLUSION This study revealed that the presence of f-QRS in ECG is associated with higher in-hospital all-cause mortality in patients with severe COVID-19. f-QRS is an easily applicable simple indicator to predict the risk of death in these patients.
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Affiliation(s)
- İbrahim Halil Özdemir
- Department of Cardiology, Manisa City Hospital; Manisa-Turkey;Department of Cardiology, Merkez Efendi State Hospital; Manisa-Turkey
| | - Bülent Özlek
- Department of Cardiology, Faculty of Medicine, Sıtkı Koçman University; Muğla-Turkey
| | - Mehmet Burak Özen
- Department of Cardiology, Manisa City Hospital; Manisa-Turkey;Department of Cardiology, Merkez Efendi State Hospital; Manisa-Turkey
| | - Ramazan Gündüz
- Department of Cardiology, Manisa City Hospital; Manisa-Turkey;Department of Cardiology, Merkez Efendi State Hospital; Manisa-Turkey
| | - Nurullah Çetin
- Department of Cardiology, Faculty of Medicine, Celal Bayar University; Manisa-Turkey
| | - Eda Özlek
- Department of Cardiology, Faculty of Medicine, Sıtkı Koçman University; Muğla-Turkey
| | - Bekir Sedat Yıldız
- Department of Cardiology, Faculty of Medicine, Celal Bayar University; Manisa-Turkey
| | - Hakan Tıkız
- Department of Cardiology, Faculty of Medicine, Celal Bayar University; Manisa-Turkey
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