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


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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    • "Slurring and broad notching in wide premature ventricular contractions (QRS duration N 160 ms), were also simple and reliable markers of dilated globally hypokinetic left ventricle in another study [8]. Another study included patients referred for nuclear perfusion scan in a cardiac center, and showed that the patients with FQRS had lower ejection fraction [4]. "
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    ABSTRACT: Background: Fragmented QRS (FQRS) in 12 lead ECG was recently correlated with various outcomes in ischemic and non-ischemic heart disease. We studied the relationship between FQRS and ejection fraction (EF) in heart failure patients with QRS < 120 ms. Methods: Medical records and echocardiograms of 339 patients admitted with CHF were reviewed. ECGs were read twice by a reader blinded to all data. Results: 70 patients with wide QRS were excluded; 63 patients had FQRS and 206 patients did not have FQRS. FQRS group were more likely to be black (OR = 2.17; p = 0.0093), and diabetic (OR = 1.79; p = 0.0451). ROC curve analysis revealed a significant relationship between EF and FQRS (p = 0.002). At EF of 48%, OR for FQRS was 4.36 (95% CI: 2.1-9.05; p < .0001). Adjustment for race and diabetes did not change the OR, or confidence intervals (Adjusted OR for race: 4.08 (95% CI: 1.06-15.67; p = 0.04); for diabetes: 4.13 (95% CI: 1.46-11.69; p = 0.008)). There was a significant difference in EF between patients with FQRS involving ≥ 2 ECG areas and non-FQRS group (p < 0.05), but not between patients with ≥ 2 vs. one area, or 1 area vs. non-FQRS. Conclusion: In heart failure patients with QRS < 120 ms, FQRS was observed more frequently in persons of black race and in diabetics and was associated with lower EF. This was mainly seen in patients with FQRS involving ≥ 2 ECG areas.
    Full-text · Article · Aug 2015
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    • "Another study has shown that there is a relationship between the leads where fragmented QRS is present in electrocardiograms and the sites of delayed gadolinium enhancement in magnetic resonance imaging in cardiac sarcoidosis[22]. Furthermore, fragmented QRS complexes are useful to predict arrhythmia events in coronary artery disease, non-ischemic cardiomyopathies , and inherited arrhythmia syndromes232425. Consistent with previous findings, we found that fragmented QRS complexes were present in the baseline electrocardiogram in 3 of 4 patients who developed ventricular tachyarrhythmias and that fragmented QRS complexes were associated with the occurrence of cardiac events in extracardiac sarcoidosis. "
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    ABSTRACT: Cardiac involvement is a leading cause of death from sarcoidosis. Because the efficacy of corticosteroid treatment is limited in patients with cardiac manifestation, early diagnosis is important. However, cardiac involvement is difficult to identify at early stages and is often underdiagnosed. Therefore, this study aimed to identify electrocardiographic risk factors for cardiac events in patients with extracardiac sarcoidosis. This prospective observational cohort study included 227 patients with extracardiac sarcoidosis who did not have any cardiac manifestation (age, 49±17years; women, 63%). We studied the association of electrocardiographic abnormalities with developing cardiac manifestations. During a follow-up of 6.3±3.7years, 11 patients developed cardiac events, including advanced atrioventricular block (4 patients), ventricular tachycardia (4 patients), and systolic dysfunction (3 patients). All patients had electrocardiographic abnormalities prior to the development of cardiac events. In multivariate analyses, the baseline heart rate and PR interval were associated with increased risk of developing cardiac events. The QRS duration and corrected QT interval were not associated with cardiac manifestations. The multivariate analyses also revealed that baseline conduction disorder, ST segment/T wave abnormalities, and fragmented QRS complexes were associated with cardiac events. Electrocardiographic abnormalities occurred prior to cardiac events in extracardiac sarcoidosis. Patients with electrocardiographic abnormalities may require further evaluation for cardiac involvement and careful follow-up. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Full-text · Article · Mar 2015 · International journal of cardiology
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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.
    Full-text · Article · Nov 2014
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