Das MK, Saha C, El Masry H, et al. Fragmented QRS on a 12-lead ECG: a predictor of mortality and cardiac events in patients with coronary artery disease

Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, United States
Heart Rhythm (Impact Factor: 5.08). 11/2007; 4(11):1385-92. DOI: 10.1016/j.hrthm.2007.06.024
Source: PubMed

ABSTRACT Fragmented QRS (fQRS) on a 12-lead electrocardiogram (ECG) is associated with myocardial scar in patients with coronary artery disease (CAD).
We postulated that fQRS is a predictor of cardiac events and mortality in patients who have known CAD or who are being evaluated for CAD.
The cardiac events (myocardial infarction, need for revascularization, or cardiac death) and all-cause mortality were retrospectively reviewed in 998 patients (mean age 65.5 +/- 11.9 years, male 967) who underwent nuclear stress test. The fQRS on a 12-lead ECG included various RSR' patterns (> or =1 R' prime or notching of S wave or R wave) without typical bundle branch block in 2 contiguous leads corresponding to a major coronary artery territory.
All-cause mortality (93 [34.1%] vs 188 [25.9%]) and cardiac event rate (135 [49.5%] vs 200 [27.6%]) were higher in the fQRS group compared with the non-fQRS group during a mean follow-up of 57 +/- 23 months. A Kaplan-Meier survival analysis revealed significantly lower event-free survival for cardiac events (P <.001) and all-cause mortality (P = .02). Multivariate Cox regression analysis revealed that significant fQRS was an independent significant predictor for cardiac events but not for all-cause mortality. The Kaplan-Meier survival analysis showed no significant difference between fQRS and Q waves groups for cardiac events (P = .48) and all-cause mortality (P = .08).
The fQRS is an independent predictor of cardiac events in patients with CAD. It is associated with significantly lower event-free survival for a cardiac event on long-term follow-up.

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    • "In previous studies of fQRS, it has been postulated that the increased cardiac event rate and mortality associated with the presence of fQRS reflects an association between the fQRS and significant myocardial disease [9] [20]. In this cohort of LVAD-supported advanced heart failure patients, fQRS was a frequent finding on pre-LVAD ECGs, but this alone was not associated with decreased survival or survival to cardiac transplantation at 30 months. "
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    ABSTRACT: Background: In patients with heart disease, the presence of a fragmented QRS complex (fQRS) on the surface electrocardiogram (ECG) is associated with an increased risk of mortality. We sought to evaluate the prevalence and location of fQRS before and after left ventricular assist device (LVAD) implantation and any associated risk of mortality. Methods and results: Twelve-lead surface ECGs before (pre-LVAD, n. =. 98) and after (early [<. 7. days], n. =. 96, and late [≥. 30. days], n. =. 85, post-LVAD) LVAD implantation were evaluated for fQRS. Mortality data were gathered via review of medical records. The prevalence of fQRS increased significantly following LVAD implantation on early post-LVAD ECGs (31% to 47%, p. <. 0.01). Patients with fQRS in the anterior territory (precordial leads V1 to V5) on late post-LVAD ECGs had decreased survival or survival to cardiac transplantation over a 30. month follow-up period compared with patients who did not exhibit anterior fQRS (30% and 59%, respectively, p. <. 0.01). Conclusions: The prevalence of fragmented QRS on 12-lead ECG increases significantly in the anterior territory following LVAD implantation and is associated with decreased survival.
    11/2014; 357. DOI:10.1016/j.ijcha.2014.10.017
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    • "The presence of fQRS complexes in a routine 12-lead electrocardiography (ECG) is a marker for abnormal cardiac depolarisation. It has been demonstrated that the presence of fQRS in patients with coronary artery disease (CAD) has been associated with regional myocardial damage, increased adverse cardiac events, and decreased event-free survival.9)10)11) Hence, fQRS may be a reliable indicator of past myocardial ischaemia in the absence of Q waves. "
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    ABSTRACT: Background and Objectives Coronary artery ectasia (CAE) is an angiographic finding characterized by dilation of an arterial segment with a diameter at least 1.5 times that of its adjacent normal coronary artery. Fragmented QRS (fQRS) complexes are electrocardiographic signals which reflect altered ventricular conduction around regions of a myocardial scar and/or ischaemia. In the present study, we aimed to evaluate the presence of fQRS in patients with CAE. Subjects and Methods The study population included 100 patients with isolated CAE without coronary artery disease (CAD) and 80 angiographically normal controls. fQRS was defined as the presence of an additional R wave or notching of R or S wave or the presence of fragmentation in two contiguous leads corresponding to a major coronary artery territory. Results The two groups were similar in terms of age, sex, hypertension, dyslipidemia, and family history of CAD. The presence of fQRS was significantly (p<0.05) higher in the CAE group than that in the normal coronary artery group (29% vs. 6.2%, p=0.008). Isolated CAE were detected most commonly in the right coronary artery (61%), followed by left anterior descending artery (52%), left circumflex artery (36%), and left main artery (9%). Multivariate stepwise logistic regression analysis showed that CAE {odds ratio (OR) 1.412; 95% confidence interval (CI) 1.085-1.541; p=0.003} and diabetes (OR 1.310; 95% CI 1.025-1.482; p=0.041) were independently associated with fQRS. Conclusion The presence of fragmented QRS associated with increased risk for arrhythmias and cardiovascular mortality was significantly higher in patients with CAE than in patient with normal coronary artery. Further studies are needed to determine whether the presence of fragmented QRS is a possible new risk factor for patients with CAE.
    Korean Circulation Journal 09/2014; 44(5):307-11. DOI:10.4070/kcj.2014.44.5.307 · 0.75 Impact Factor
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    • "Other repolarization parameters such as Tp-Te and (Tp-Te)d have been studied in other populations such as hypertrophic cardiomyopathy [36] and Brugada syndrome [21] with evidence that these parameters may be a better predictor than QTd for inducible ventricular arrhythmias, spontaneous ventricular arrhythmias, need for appropriate ICD therapy [37] and SCD.[38] The depolarization parameter, fragmented QRS (fQRS), is a known marker of increased mortality in CAD [19] and a marker of increased arrhythmic events in CAD, ischemic CM and NICM [39,40] as well as Brugada syndrome [41], but has not been previously studied in a CD population. These parameters need further data in CD. "
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    ABSTRACT: Objective The goal of this study was to examine the association between ECG repolarization parameters and mortality in Chagas disease (CD) patients living in the United States. Methods CD patients with cardiomyopathy (CM) and bundle branch block (BBB) or BBB alone were compared to age- and sex-matched controls. QT interval, QT dispersion (QTd), T wave peak to T wave end duration (Tp-Te) and T wave peak to T wave end dispersion ((Tp-Te)d) were measured. Presence of fractionated QRS (fQRS) was also assessed. The main outcome measure was the association between ECG parameters and mortality or need for cardiac transplant. Results A total of 18 CM and 13 BBB CD patients were studied with 97% originating from Mexico or Central America. QTd (60.0±15.0 ms vs 43.5±9.8 ms, P=0.0002), Tp-Te (102.6±29.3 ms vs 77.1±11.0 ms, P=0.0002) and (Tp-Te)d (39.5±9.4 ms vs 22.7±7.6 ms, P<0.0001) were prolonged in CD CM patients compared to CM controls. Chagas CM patients had more fQRS then controls (84.2±0.10% vs 33.3±0.11%, p=0.0005). QTd (59.9±15.0 ms vs 29.5±6.9 ms, P=0.0001) and (Tp-Te)d (40.0±15.9 ms vs 18.5±5.4 ms, p<0.0001) were longer in the CD BBB group compared to BBB controls. Univariate analysis showed QTd (56.9±15.0 ms vs 46.5±17.3 ms, p=0.0412) and (Tp-Te)d (36.8±13.5 ms vs 28.5±13.3 ms, p=0.0395) were associated with death and/or need for cardiac transplant. Conclusion Our results indicate that P-max and PD are useful electrocardiographic markers for identifying the β-TM-high-risk patients for AF onset, even when the cardiac function is conserved.
    Indian pacing and electrophysiology journal 07/2014; 14(4):171-80.
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