BackgroundFragmented 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.MethodsMedical records and echocardiograms of 339 patients admitted with CHF were reviewed. ECGs were read twice by a reader blinded to all data.Results70 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.ConclusionIn 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.

Acute myocardial infarction during pregnancy or the postpartum period is rare. We report a case of a 39-year-old postpartum woman who developed non-ST-elevation myocardial infarction due to severe diffuse coronary vasospasm. To our knowledge, this is the first case of angiographically evidenced coronary vasospasm, in a postpartum woman, with resistance to intracoronary nitroglycerin.

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ObjectiveRed-cell distribution width (RDW) has been identified as a novel prognostic marker in a heterogeneous group of heart failure patients. In this group, diastolic dysfunction is associated with worse outcome. As the evidence is limited, the aim of the present study was to assess the relationship of RDW to diastolic markers in patients with left ventricular dysfunction (LVD) diagnosed during cardiac catheterization.MethodsClinical and angiographic data were collected retrospectively on a total of 291 stable patients (mean age 62 years, 199 males) with systolic dysfunction documented during cardiac catheterization in a regional medical center between January 2006 and December 2010.ResultsPositive association was seen between RDW and Left ventricular end diastolic pressure (LVEDP), estimated systolic pulmonary arterial pressure(sPAP), and left atrial dimension (LAD) (r: 0.18, 0.24, 0.28, respectively; p:<0.05).Three year retrospective survival analysis for 108 patients admitted in the first 2 years showed a statistically significant decrease in survival patients with high RDW(> 14.5) vs. normal RDW (73%vs.88%;log rank p:0.03). This was seen even in the asymptomatic subgroup (71% vs. 94%; log rank p: 0.01).ConclusionRDW correlates with markers of diastolic dysfunction in patients with LVD. Additionally, in patients asymptomatic LVD, high RDW is still associated with lower survival.

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