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Luo G, Li Q, Duan J, Peng Y, Zhang Z. The Predictive Value of Fragmented QRS for Cardiovascular Events in Acute Myocardial Infarction: A Systematic Review and Meta-Analysis. Front Physiol 2020; 11:1027. [PMID: 33117185 PMCID: PMC7574772 DOI: 10.3389/fphys.2020.01027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/27/2020] [Indexed: 12/22/2022] Open
Abstract
Objective: Fragmented QRS (fQRS) have been reported as a predictor of major adverse cardiac events (MACE) and mortality in several studies on cardiovascular disease. However, most studies have yielded discrepant results. This study aimed to explore the correlation between fQRS and cardiovascular events in patients with acute myocardial infarction (AMI) during their hospital stay and follow-up period, and the predictive value of fQRS in the prognosis of AMI. Methods: We searched for relevant studies in four databases, Medline, Embase, PubMed, and the Cochrane Library from January 2010 to March 2020. Our initial search yielded 585 articles. Of these, we screened 19 studies, and finally included a total of 6,914 patients in this analysis, comparing death events or MACE in AMI patients with or without fQRS. Results: Fragmented QRS was significantly associated with a higher risk of in-hospital mortality (OR, 3.97; 95% CI, 2.45-6.44; p < 0.00001), long-term mortality (OR, 2.93; 95% CI, 1.76-4.88; p < 0.0001), in-hospital MACE (OR, 2.48; 95% CI, 1.62-3.80; p < 0.0001), and long-term MACE (OR, 3.81; 95% CI, 2.21-6.57; p < 0.00001). In particular, it demonstrated a higher predictive value for in-hospital cardiovascular mortality and long-term all-cause mortality in AMI patients and in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI). Moreover, fQRS was also associated with an increased risk of ventricular arrhythmias (OR, 2.76; 95% CI, 1.72-4.43; p < 0.0001) and heart failure (OR, 1.65; 95% CI, 1.02-2.66; p = 0.04). Fragmented QRS was negatively associated with left ventricular ejection function (LVEF) (MD, -5.47; CI, [-7.03, -3.91]; p < 0.00001) and positively associated with a high incidence of coronary artery triple vessel lesions (OR, 2.14; 95% CI, 1.31-3.51; p = 0.002) in AMI patients. Conclusion: Fragmented QRS is significantly associated with in-hospital and long-term mortality and MACE in patients with AMI, as well as ventricular arrhythmias and heart failure. Furthermore, it may be a marker of mortality and MACE risk. Moreover, fQRS also indicates a reduced LVEF and a high incidence of coronary artery triple vessel lesions in AMI patients. Meta-analysis Registration: https://www.crd.york.ac.uk/prospero; ID: CRD42020171668.
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Affiliation(s)
- Gongming Luo
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
- Heart Center, the First Hospital of Lanzhou University, Lanzhou, China
| | - Qian Li
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Jingwei Duan
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
- Heart Center, the First Hospital of Lanzhou University, Lanzhou, China
| | - Yu Peng
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
- Gansu Key Laboratory of Cardiovascular Disease, Lanzhou, China
| | - Zheng Zhang
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
- Heart Center, the First Hospital of Lanzhou University, Lanzhou, China
- Gansu Key Laboratory of Cardiovascular Disease, Lanzhou, China
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Nikoo MH, Arjangzadeh A, Pakfetrat M, Boogar SS, Mohammadkarimi V, Ostovan VR, Khodamoradi Z, Roozbeh J, Khalili M, Shirazi FKH, Kouhi P, Heydari ST. Electrocardiographic findings of methanol toxicity: a cross-sectional study of 356 cases in Iran. BMC Cardiovasc Disord 2020; 20:415. [PMID: 32928149 PMCID: PMC7488223 DOI: 10.1186/s12872-020-01691-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/27/2020] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Methanol is widely used in industry; however, methanol poisoning is not common. In this regard, a number of outbreaks have been recently reported due to inappropriate processing of alcoholic beverages. Shiraz, a city located in the southern part of Iran, faced one of such outbreaks in 2020 during COVID-19 pandemic. There is no sufficient literature on the electrocardiographic findings in methanol toxicity. This study aimed to address this gap in the literature. METHOD A total of 356 cases with methanol toxicity referred to Shiraz University of Medical Science Tertiary Hospitals (Faghihi and Namazi) in March and April, 2020. The clinical findings of blindness and impaired level of consciousness, lab data such as arterial blood gas, electrolytes, and creatinine, and the most common findings from ECGs were collected. RESULTS The most common ECG findings were J point elevation (68.8%), presence of U wave (59.2%), QTc prolongation (53.2% in males and 28.6% in females), and fragmented QRS (33.7%). An outstanding finding in this study was the presence of myocardial infarction in 5.3% of the cases. This finding, to the best of our knowledge, has only been reported in a few case reports. Brugada pattern (8.1%) and Osborn wave (3.7%) were the other interesting findings. In multivariate analysis, when confounding factors were adjusted, myocardial infarction, atrioventricular conduction disturbances, sinus tachycardia, and the prolonged QTC > 500 msecond were four independent factors correlated with methanol toxicity severity measured with arterial blood PH on arterial blood gas measurements, with odds ratios of 12.82, 4.46, 2.32 and 3.15 (P < 0.05 for all), respectively. CONCLUSION Electrocardiographic variations during methanol intoxication are remarkable and well-correlated with poisoning severity. Myocardial infarction was an egregious and yet a common concerning finding in this sample, which need to be ruled out in methanol toxicity.
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Affiliation(s)
- Mohammad Hossein Nikoo
- Non-communicable Disease Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Maryam Pakfetrat
- Department of Internal Medicine, Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahrokh Sadeghi Boogar
- Department of Internal Medicine, School Of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vahid Mohammadkarimi
- Department of Internal Medicine, School Of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vahid Reza Ostovan
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Poostchi Eye Research Centre, Ophthalmology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zohre Khodamoradi
- Department of Internal Medicine, School Of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jamshid Roozbeh
- Department of Internal Medicine, Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammadreza Khalili
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Poostchi Eye Research Centre, Ophthalmology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Paryia Kouhi
- Department of Internal Medicine, School Of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Taghi Heydari
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Building No.2.8th Floor School of Medicine Zand Avenue, P.O.Box:71345-1877, Shiraz, Iran
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Younis AS, El-Halag MI, ElBadry MA, Abbas NIM. Fragmented QRS complex frequency and location as predictor of cardiogenic shock and mortality following acute coronary syndrome. Egypt Heart J 2020; 72:43. [PMID: 32705448 PMCID: PMC7378133 DOI: 10.1186/s43044-020-00076-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Worldwide, coronary heart disease (CHD) is topping the foremost important chief causes of mortality. Fragmented QRS (f-QRS) is a pattern of QRS complex in 12 leads surface ECG which showed a promising value in predicting the outcome in cardiac diseases including ischemic heart disease. We aimed to research the importance of using f-QRS as a non-invasive and cheap tool for the prediction of cardiogenic shock and mortality in acute coronary syndrome (ACS). METHODS A retrospective study includes eighty four critically ill ACS patients. Patients were classified consistent with the presence or absence of fragmented QRS into two groups (46 and 38 patients respectively). Exclusion criteria include past history of important ischemic events (MI, PCI, and CABG), permanent AF, and/or cardiomyopathy. No statistical significant differences were detected between the 2 groups as regards the age, gender, major risk factors of ischemic heart condition, cardiac bio-markers, Killip class, LVEF, updated GRACE risk score of ACS, and in-hospital mortality. RESULTS A number value of f-QRS leads > 3 yields sensitivity and specificity (83.3% and 72.5% respectively) for predicting hospital mortality. The f-QRS group was further split-up according to the numbers of f-QRS leads into 2 subgroups; subgroup (A1) including patients with > 3 f-QRS leads and subgroup (A2) including patients ≤ 3 f-QRS leads. Subgroup (A2) showed considerable difference as regards some important variables including a higher SBP (P = 0.016), a slower HR (P = 0.014), a lower up-dated GRACE risk score (3.22 ± 6.95 vs 6.81 ± 12, P value 0.048), and a lower rate of hospital death (1/30 vs. 5/16, P = 0.015). Anterior f-QRS showed statistically significant higher HR, lower SBP, a higher frequency of shock, a higher updated GRACE risk score, and a higher chance of in-hospital mortality (P = 0.004) compared to non-anterior f-QRS. CONCLUSION The position and number of f-QRS leads provide a non-invasive and a readily accessible tool to predict the prognosis, occurrence of cardiogenic shock, and in-hospital mortality.
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Affiliation(s)
- Ahmad Salah Younis
- Department of Critical Care Medicine, Faculty of Medicine, Cairo University, Kasr alAiny Street, Cairo, 11562, Egypt
| | - Moataz Ibrahim El-Halag
- Department of Critical Care Medicine, Faculty of Medicine, Cairo University, Kasr alAiny Street, Cairo, 11562, Egypt
| | - Mahmoud Ali ElBadry
- Department of Critical Care Medicine, Faculty of Medicine, Cairo University, Kasr alAiny Street, Cairo, 11562, Egypt
| | - Nora Ismail Mohamed Abbas
- Department of Critical Care Medicine, Faculty of Medicine, Cairo University, Kasr alAiny Street, Cairo, 11562, Egypt.
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Rezaee M, Kheirkhah J, Salari A, Mirbolouk F, Moayerifar M, Mirrazeghi SF, Nikfarjam S, Leili EK, Gholipour M. Investigation of short-term prognosis of fragmented QRS complexes in patients with acute myocardial infarction in two groups that received invasive and fibrinolytic therapy. Indian Heart J 2020; 72:46-51. [PMID: 32423560 PMCID: PMC7231857 DOI: 10.1016/j.ihj.2020.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/31/2019] [Accepted: 01/08/2020] [Indexed: 12/02/2022] Open
Abstract
Background Studies have shown that the primary causes of death in patients with acute coronary syndrome are arrhythmias and heart failure. The aim of this study is to evaluate the short-term prognosis of fragmented QRS (f-QRS) in patients with acute myocardial infarction (MI). Methods This study was a prospective and longitudinal analytic study performed on all patients with acute MI admitted to Rasht Heshmat Hospital Emergency during 2018–2019. Serial Electrocardiography (ECG) was performed in the emergency room after patient admission and was repeated 24 h after percutaneous coronary intervention and fibrinolytic therapy, as well as at the time of patient discharge. Short-term prognosis of f-QRS in patients was evaluated by a cardiologist within admission, 40 days after hospitalization and three months later again. Results In this study, 453 patients with MI were evaluated in two treatment methods of fibrinolytic and invasive with and without f-QRS. Based on the data of this study, the four study groups had no statistically significant difference in arrhythmia (p = 0.196). In addition, the effect of study groups on left ventricular ejection fraction index was not statistically significant (p = 0.597). The probability of adverse outcomes occurrence was not statistically significant among the four groups (p = 0.07). Conclusion The final results of this study showed that there was no significant difference between the four study groups and arrhythmia status. Therefore, f-QRS was not introduced as an independent predictor of arrhythmia in patients with acute MI.
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Affiliation(s)
- Masoomeh Rezaee
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Jalal Kheirkhah
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Arsalan Salari
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Fardin Mirbolouk
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mani Moayerifar
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Seyedeh Fatemeh Mirrazeghi
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Salman Nikfarjam
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ehsan Kazemnezhad Leili
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mahboobe Gholipour
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
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Xu S, Yang L, Hong D, Chen L, Wang X. Predictive value of fragmented QRS for ventricular tachyarrhythmias in patients with acute myocardial infarction: A meta-analysis. Eur J Clin Invest 2020; 50:e13182. [PMID: 31675435 DOI: 10.1111/eci.13182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 10/17/2019] [Accepted: 10/31/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Recent studies indicated that fragmented QRS (fQRS) is associated with malignant cardiac arrhythmias in patients with acute myocardial infarction (AMI). However, a systematic review and meta-analysis on this issue still have not been conducted. Thus, we performed a systematic review and meta-analysis to access the predictive value of fQRS for ventricular tachyarrhythmias (VTAs) in patients with AMI. MATERIALS AND METHODS We searched the databases of PubMed, Embase and Cochrane Library for relevant studies until 8 June 2019. We included studies which compared VTAs in AMI patients with fQRS vs without fQRS. RESULTS Six studies enrolling 2218 ST-segment elevation myocardial infarction (STEMI) patients were included in this meta-analysis. The fQRS was significantly associated with greater risk of VTAs in STEMI patients (Odds ratio [OR] 2.81, 95% confidence interval (CI) 1.99-3.95, P < .00001; I2 = 30%). This association was still significant both in prospective (OR 3.25, 95% CI 1.94-5.46, P < .00001; I2 = 0%) and retrospective (OR 2.40, 95% CI 1.22-4.74, P = .01; I2 = 54%) studies. In particularly, fQRS in patients with low left ventricular ejection fraction (≤50%) (OR 2.97, 95% CI 1.88-4.70, P < .00001; I2 = 21%) or <60 years old (OR 3.07, 95% CI 2.02-4.66, P < .00001; I2 = 0%) tripled the risk of VTAs during AMI. CONCLUSION Our meta-analysis demonstrated that fQRS increases the risk of developing VTAs in patients with STEMI.
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Affiliation(s)
- Shangbo Xu
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Shantou University Medical College, Shantou, China
| | - Lihua Yang
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Danhua Hong
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Lan Chen
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Xin Wang
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
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Sheng QH, Hsu CC, Li JP, Hong T, Huo Y. Combining fragmented QRS and TIMI score for predicting in-hospital short-term prognosis after acute myocardial infarction. J Zhejiang Univ Sci B 2018; 19:349-353. [PMID: 29732745 DOI: 10.1631/jzus.b1700413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Acute myocardial infarction (AMI) has a high mortality rate and poor prognosis for patients. The primary causes of death are arrhythmia and heart failure. For patients admitted because of myocardial infarction, various risk evaluations are initiated to foresee possible complications. The thrombolysis in myocardial infarction (TIMI) risk score, which can be used to predict the prognosis and the need for revascularisation, is the most convenient and commonly used system, but is inadequate for AMI patients on admittance. Fragmented QRS (fQRS) has been shown to be a valuable electrocardiographic (ECG) index for predicting the prognosis of patients with coronary heart disease. Also, fQRS is considered to predict an increased likelihood of a poor outcome and mortality in patients with coronary artery disease (CAD), even for some successfully revascularized AMI patients. So what would happen if fQRS and the TIMI risk score were combined? This study focused on the investigation of the short-term prognostic value of fQRS combined with the TIMI risk score for patients with AMI.
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Affiliation(s)
- Qin-Hui Sheng
- Department of Cardiology, Peking University First Hospital, Beijing 100034, China
| | - Chih Chi Hsu
- Department of Cardiology, Peking University First Hospital, Beijing 100034, China
| | - Jian-Ping Li
- Department of Cardiology, Peking University First Hospital, Beijing 100034, China
| | - Tao Hong
- Department of Cardiology, Peking University First Hospital, Beijing 100034, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing 100034, China
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Chávez-González E, Rodríguez Jiménez A, Moreno-Martínez F. QRS duration and dispersion for predicting ventricular arrhythmias in early stage of acute myocardial infraction. MEDICINA INTENSIVA (ENGLISH EDITION) 2017; 41:347-355. [DOI: 10.1016/j.medine.2017.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Chávez-González E, Rodríguez Jiménez AE, Moreno-Martínez FL. QRS duration and dispersion for predicting ventricular arrhythmias in early stage of acute myocardial infraction. Med Intensiva 2017; 41:347-355. [PMID: 28284496 DOI: 10.1016/j.medin.2016.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 08/27/2016] [Accepted: 09/17/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine the relationship between QRS duration and dispersion and the occurrence of ventricular arrhythmias in early stages of acute myocardial infarction (AMI). DESIGN A retrospective, longitudinal descriptive study was carried out. SETTING Hospital General Universitario "Camilo Cienfuegos", Sancti Spíritus, Cuba. Secondary health care. PATIENTS OR PARTICIPANTS A total of 209 patients diagnosed with ST-segment elevation AMI from January 2012 to June 2014. MAIN VARIABLES OF INTEREST The duration and dispersion of the QT interval, corrected QT interval, and QRS complex were measured in the first electrocardiogram performed at the hospital. The presence of ventricular tachycardia/fibrillation was assessed during follow-up (length of hospital stay). RESULTS Arrhythmias were found in 46 patients (22%); in 25 of them (15.9%), arrhythmias originated in ventricles, and were more common in those subjects with extensive anterior wall AMI, which was responsible for 81.8% of the ventricular fibrillations and more than half (57.1%) of the ventricular tachycardias. The widest QRS complexes (77.3±13.3 vs. 71.5±6.4ms; P=.029) and their greatest dispersion (24.1±16.2 vs. 16.5±4.8ms; P=.019) were found on those leads that explore the regions affected by ischemia. The highest values of all measurements were found in extensive anterior wall AMI, with significant differences: QRS 92.3±18.8ms, QRS dispersion 37.9±23.9ms, corrected QT 518.5±72.2ms, and corrected QT interval dispersion 94.9±26.8ms. Patients with higher QRS dispersion values were more likely to have ventricular arrhythmias, with cutoff points at 23.5ms and 24.5ms for tachycardia and ventricular fibrillation, respectively. CONCLUSIONS Increased QRS duration and dispersion implied a greater likelihood of ventricular arrhythmias in early stages of AMI than increased duration and dispersion of the corrected QT interval.
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Affiliation(s)
- E Chávez-González
- Departamento de Electrofisiología y Arritmias, Cardiocentro Ernesto Che Guevara, Santa Clara, Villa Clara, Cuba
| | - A E Rodríguez Jiménez
- Servicio de Cardiología, Hospital Universitario Camilo Cienfuegos, Sancti Spíritus, Cuba
| | - F L Moreno-Martínez
- Unidad de Hemodinámica y Cardiología Intervencionista, Cardiocentro Ernesto Che Guevara, Santa Clara, Villa Clara, Cuba.
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Li M, Wang X, Mi SH, Chi Z, Chen Q, Zhao X, Nie SP. Short-term Prognosis of Fragmented QRS Complex in Patients with Non-ST Elevated Acute Myocardial Infarction. Chin Med J (Engl) 2017; 129:518-22. [PMID: 26904984 PMCID: PMC4804431 DOI: 10.4103/0366-6999.176989] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: There remains significant debate as to the relationship between fragmented QRS (fQRS) complexes on electrocardiogram (ECG) and acute myocardial infarction (AMI). Few studies have reported on this relationship in non-ST elevated AMI (NSTEMI), and thus, we attempt to assess this relationship and its potential short-term prognostic value. Methods: This was a single-center, observational, retrospective cohort study. A total of 513 consecutive patients (399 men, 114 women) with NSTEMI within 24 h who underwent coronary angiography at our department, between January 1, 2014, and December 31, 2014. Patients were divided into 2 groups according to the presence or absence of fQRS complex on the admission ECG. fQRS complexes were defined as the existence of an additional R’ or crochetage wave, notching in the nadir of the S wave, RS fragmentation, or QS complexes on 2 contiguous leads. All patients were followed up for 6 months, and all major adverse cardiac events (MACE) were recorded. Results: In this study, there were 285 patients with fQRS ECG in the 513 patients with NSTEMI. The number of patients with 0–2 coronary arteries narrowed by ≥50% in fQRS group were less while patients with 3 narrowed arteries were more than in the non-fQRS group (P = 0.042). There were fewer Killip Class I patients in the fQRS group (P = 0.019), while Killip Class II, III, and IV patients were more in the fQRS group than in the non-fQRS group (P = 0.019). Left ventricular ejection fraction levels were significantly lower in the fQRS group (P = 0.021). Baseline total cholesterol, low-density lipoprotein, creatinine, creatine kinase, homocysteine, high-sensitivity C-reactive protein (CRP), and red blood cells distribution width levels were significantly higher in the fQRS group. Total MACE (MACE, P = 0.028), revascularization (P = 0.005), and recurrent angina (P = 0.005) were also significantly greater in the fQRS group. On final logistic regression analysis, after adjusting for baseline variables, the following variables were independent predictors of fQRS: Coronary artery narrowing (P = 0.035), Killip classification (P = 0.026), and total cholesterol (P = 0.002). The following variables were found to be independent predictors of preoperative MACE: Hemoglobin (P = 0.000), gender (P = 0.026), fQRS (P = 0.016), and time from myocardial infarction to balloon or coronary artery bypasses grafting (P = 0.013). Conclusions: The fQRS complexes are commonly present in NSTEMI and the fQRS complexes are an independent predictor of MACE in NSTEMI patients. The number of narrowed coronary arteries, Killip classification, and total cholesterol are all independent predictors of the fQRS complexes.
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Affiliation(s)
| | | | | | | | | | | | - Shao-Ping Nie
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
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Korkmaz A, Yildiz A, Demir M, Ozyazgan B, Sahan E, Acar B, Guray U, Ileri M, Elalmis OU. The relationship between fragmented QRS and functional significance of coronary lesions. J Electrocardiol 2017; 50:282-286. [PMID: 28117101 DOI: 10.1016/j.jelectrocard.2017.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Recently fragmented QRS (fQRS) on electrocardiography (ECG) has been introduced as a predictor of myocardial scarring and myocardial ischemia in coronary artery disease (CAD). OBJECTIVE The 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. METHODS A 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. RESULTS Of 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. CONCLUSION In clinical practice, the presence of fQRS on ECG is associated with myocardial ischemia in patients with intermediate coronary stenosis.
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Affiliation(s)
- Ahmet Korkmaz
- Ankara Numune Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Abdulkadir Yildiz
- Bezmialem Vakif University Hospital, Department of Cardiology, Istanbul, Turkey.
| | - Mevlut Demir
- Ankara Numune Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Burcu Ozyazgan
- Ankara Numune Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Ekrem Sahan
- Atatürk Pulmonary Disease and Thorasic Surgery Hospital, Department of Cardiology, Ankara, Turkey
| | - Burak Acar
- Turkey Yuksek Ihtisas Hospital, Department of Cardiology, Ankara, Turkey
| | - Umit Guray
- Ankara Numune Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Mehmet Ileri
- Ankara Numune Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Ozgul Ucar Elalmis
- Ankara Numune Training and Research Hospital, Department of Cardiology, Ankara, Turkey
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Güngör B, Özcan KS, Karataş MB, Şahin İ, Öztürk R, Bolca O. Prognostic Value of QRS Fragmentation in Patients with Acute Myocardial Infarction: A Meta-Analysis. Ann Noninvasive Electrocardiol 2016; 21:604-612. [PMID: 27018003 DOI: 10.1111/anec.12357] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 01/23/2016] [Indexed: 12/12/2022] Open
Abstract
AIMS 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). METHODS AND RESULTS 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.
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Affiliation(s)
- Barış Güngör
- Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey
| | - Kazım Serhan Özcan
- Department of Cardiology, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Mehmet Baran Karataş
- Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey.
| | - İrfan Şahin
- Department of Cardiology, Bağcılar Training and Research Hospital, Istanbul, Turkey
| | - Recep Öztürk
- Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey
| | - Osman Bolca
- Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey
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12
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Tanriverdi Z, Dursun H, Kaya D. The Importance of the Number of Leads with fQRS for Predicting In-Hospital Mortality in Acute STEMI Patients Treated with Primary PCI. Ann Noninvasive Electrocardiol 2015; 21:413-9. [PMID: 26568401 DOI: 10.1111/anec.12329] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 08/30/2015] [Accepted: 09/21/2015] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Fragmented QRS (fQRS) has been shown to be related to increased cardiovascular mortality and morbidity. However, limited data are available for evaluating the relationship between the number of leads with fQRS and in-hospital all-cause mortality in patients with acute ST segment elevation myocardial infarction (STEMI). The aim of our study is to investigate the prognostic importance of the number of leads with fQRS in acute STEMI patients treated by primary percutaneous coronary intervention (PCI). METHODS Two hundred ten eligible patients with acute STEMI that underwent primary PCI were enrolled in this study. Each patient's 12-lead electrocardiography (ECG) taken in the first 48 hours was analyzed and the number of leads with fQRS were recorded. RESULTS The number derivations with fQRS were significantly higher in patients who developed in-hospital mortality than the patients who did not develop in-hospital mortality (2.6 ± 2.6 vs 0.9 ± 1.3; P = 0.002). Also, patients with ≥3 leads with fQRS had higher rate of in-hospital all-cause mortality (23.5% vs 7.4%, P = 0.009), higher frequency of Q wave (67.6% vs 36.9%, P = 0.001), and higher frequency of fQRS with Q wave (67.6% vs 15.9%, P < 0.001) than those patients with <3 leads with fQRS. By a multivariate regression analysis, the number of leads with fQRS was found to be an independent predictor of in-hospital all-cause mortality (odds ratio: 1.415, 95% confidence interval: 1.049-1.909, P = 0.023). CONCLUSIONS The number of leads with fQRS on 12-lead ECG is an independent predictor of in-hospital all-cause mortality in patients with acute STEMI treated by primary PCI.
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Affiliation(s)
| | - Huseyin Dursun
- Department of Cardiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Dayimi Kaya
- Department of Cardiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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13
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Gong B, Li Z. Total Mortality, Major Adverse Cardiac Events, and Echocardiographic-Derived Cardiac Parameters with Fragmented QRS Complex. Ann Noninvasive Electrocardiol 2015; 21:404-12. [PMID: 26523941 DOI: 10.1111/anec.12325] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Fragmented QRS complex (fQRS), an easily evaluated noninvasive electrocardiographic parameter, is associated with worse outcomes in patients with several cardiovascular conditions. The presence of fQRS on ECG may be an indicator of myocardial damage in patients with coronary artery disease (CAD). In this article, we performed a meta-analysis in order to characterize the presence of fQRS on ECG in patients with CAD. METHODS We searched English-language randomized controlled trials involving fQRS on ECG in patients with CAD (n = 3279 patients, 12 trials). Two reviewers independently extracted data. Data on LVEF, LVESD, LVEDD, LVESV, LVEDV, total mortality, stroke, and MACE were collected. fQRS was performed a comparison with non-fQRS, calculating pooled relatives risk (RRs) and weighted mean difference (WMD), and associated 95% confidence intervals (CIs). RESULTS fQRS was associated with significant increased WMD of LVEDD (WMD, 2.26; 95%CI, 0.92 to 0.36, P = 0.0009), LVESD (WMD, 2.71; 95%CI, 1.23 to 4.19, P = 0.0003), LVEDV (WMD, 31.37; 95%CI, 24.82 to 37.92, P < 0.00001), and LVESV (WMD, 28.45; 95%CI, 22.92 to 33.98, P < 0.00001). As compared to non-fQRS, fQRS increased risk of total mortality (RR, 3.09; 95%CI, 1.76 to 5.44, P < 0.0001) and MACE (RR, 2.85; 95%CI, 1.98 to 4.09, P < 0.00001) in patients with CAD. However, a decreased trend was observed for LVEF (WMD, -3.59; 95%CI, -7.05 to -0.12, P = 0.04). For the incidence of stoke, there was no difference between fQRS and non-fQRS group. CONCLUSIONS Our findings indicate that fQRS is a valuable factor to predict total mortality and MACE in patients with CAD.
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Affiliation(s)
- Bojun Gong
- Department of Cardiology, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zicheng Li
- Department of Cardiology, First Affiliated Hospital of Jinan University, Guangzhou, China
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14
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Rosengarten JA, Scott PA, Morgan JM. Fragmented QRS for the prediction of sudden cardiac death: a meta-analysis. Europace 2014; 17:969-77. [PMID: 25355781 DOI: 10.1093/europace/euu279] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 09/16/2014] [Indexed: 11/13/2022] Open
Abstract
AIMS Risk stratification of sudden cardiac death (SCD) is challenging. Fragmented QRS (fQRS) is proposed as a non-invasive electrocardiogram marker associated with mortality and SCD. Results from individual studies including small numbers of patients are discrepant. We therefore performed a meta-analysis of studies evaluating fQRS as a risk stratification tool to predict all-cause mortality and SCD. METHODS AND RESULTS Electronic databases and bibliographies were systematically searched (1996-2014). Twelve studies (5009 patients) recruiting patients with coronary artery disease or non-ischaemic cardiomyopathy met our inclusion criteria. Fragmented QRS was associated with an all-cause mortality relative risk of 1.71 (CI 1.02-2.85) and a relative risk of SCD of 2.20 (CI 1.05-4.62). Subgroup analysis demonstrated greater mortality and SCD risk in those with left ventricular ejection fraction >35% and SCD risk in those with QRS duration <120 ms. CONCLUSION Fragmented QRS is associated with all-cause mortality and the occurrence of SCD and may be suited as a marker of SCD risk. The incremental benefit of fQRS should be assessed in a randomized, prospective setting.
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Affiliation(s)
- James A Rosengarten
- Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth BH77DW, UK Faculty of Medicine, University of Southampton, Southampton, UK
| | - Paul A Scott
- King's College Hospital NHS Foundation Trust, London, UK
| | - John M Morgan
- Faculty of Medicine, University of Southampton, Southampton, UK University Hospital Southampton NHS Foundation Trust, Southampton, UK
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15
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Xu Y, Qiu Z, Xu Y, Bao H, Gao S, Cheng X. The role of fQRS in coronary artery disease. A meta-analysis of observational studies. Herz 2014; 40 Suppl 1:8-15. [PMID: 25336240 DOI: 10.1007/s00059-014-4155-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 09/05/2014] [Accepted: 09/09/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND Experimental and clinical studies have suggested that the presence of fragmented QRS complex (fQRS) is associated with various cardiovascular diseases. fQRS may predict major adverse cardiovascular events (MACE). The current meta-analysis was performed using clinical outcome studies to evaluate the role of fQRS in coronary artery disease (CAD). METHODS A systematic search of electronic databases (Cochrane, Medline, Embase and Pubmed) from their inception to April 2014 was performed. Data were extracted from applicable articles to evaluate the prognostic value of fQRS in CAD. RESULTS A total of 16 observational studies about fQRS and CAD (n = 3,997 patients) were identified. Compared with the non-fQRS group, MACE and mortality were significantly higher in the fQRS group -odds ratios (OR) 3.19, 95 % confidence interval (95 % CI) [2.3, 4.42], p < 0.00001; OR 2.24, 95 % CI [1.71, 2.94], p < 0.0001. Patients developed Q waves, anterior-wall myocardial infarction (MI), and low left ventricular ejection fraction (LVEF) more frequently in the fQRS group than in the non-fQRS group-OR 2.59, 95 % CI [1.76, 3.81], p < 0.00001; OR 2.43, 95 % CI [1.07, 5.52], p = 0.03; OR - 6.43, 95 % CI [- 9.11, - 3.74], p < 0.00001. CONCLUSION Based on current evidence, fQRS was associated with increased MACE, mortality, Q waves, anterior-wall MI, and decreased LVEF in CAD. These findings show that fQRS is a reliable marker in CAD.
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Affiliation(s)
- Y Xu
- Department of Cardiology, Institute of Cardiovascular disease, Second Affiliated Hospital of Nanchang University, 1 Minde Road, 330006, Nan Chang, Jiang Xi, China
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16
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Uslu N, Gul M, Cakmak HA, Atam A, Pusuroglu H, Satilmisoglu H, Akkaya E, Aksu HU, Kalkan AK, Surgit O, Erturk M, Aksu H, Eksik A. The assessment of relationship between fragmented QRS complex and left ventricular wall motion score index in patients with ST elevation myocardial infarction who underwent primary percutaneous coronary intervention. Ann Noninvasive Electrocardiol 2014; 20:148-57. [PMID: 25041063 DOI: 10.1111/anec.12180] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES Fragmented QRS (fQRS) has been found to be associated with high mortality and arrhythmic events in acute coronary syndromes. Regional systolic function using wall motion score index (WMSI) is an alternative to left ventricular ejection fraction (LVEF) for the assessment of left ventricular systolic function. The aim of this study was to investigate the relation between the presence of fQRS on admission electrocardiogram (ECG) and WMSI in ST elevation myocardial infarction (STEMI) underwent primary coronary intervention (PCI). The in-hospital and long-term prognostic significance of persistent fQRS was also evaluated. METHODS In this retrospective study, 542 patients with a diagnose of STEMI underwent primary PCI were included. Study patients were divided into two groups according to the presence (n = 153) or absence (n = 389) of a fQRS on admission ECG. RESULTS WMSI was found to be significantly higher in fQRS(+) group compared to the fQRS(-) group (P < 0.001). In multivariete analysis, WMSI was found to be an independent predictor of fQRS, and fQRS was inversely associated with LVEF. The in-hospital reinfarction (P = 0.003), MACE (P = 0.024), intraaortic balloon pump use (P = 0.014), and advanced heart failure (P < 0.001) were found to be significantly more frequent in the fQRS(+) group. The presence of fQRS on admission was found to be associated with an increase in long-term cardiovascular mortality (P = 0.028), and long-term all-cause mortality (P = 0.022). CONCLUSION WMSI was significantly related with the presence of the fQRS, which reflects the linking between impairment of regional left ventricular systolic function and the presence of severe myocardial injury in STEMI.
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Affiliation(s)
- Nevzat Uslu
- Cardiology Department, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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