Baseline fragmented <scp>QRS</scp> increases the risk of major arrhythmic events in hypertrophic cardiomyopathy: Systematic review and meta‐analysis

Rattanawong, Pattara; Riangwiwat, Tanawan; Kanitsoraphan, Chanavuth; Chongsathidkiet, Pakawat; Kanjanahattakij, Napatt; Vutthikraivit, Wasawat; Chung, Eugene H.

doi:10.1111/anec.12533

Cited by 15 publications

(11 citation statements)

References 16 publications

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“…And the peri‐infarct area in STEMI patient serves as a substrate for arrhythmia . Previous meta‐analyses had demonstrated that fQRS increased arrhythmic events in patients with hypertrophic cardiomyopathy and Brugada syndrome . For STEMI patients, our meta‐analysis argued that fQRS on ECG also increases the risk of VTAs 2.81‐fold.…”

Section: Discussionmentioning

confidence: 65%

Predictive value of fragmented QRS for ventricular tachyarrhythmias in patients with acute myocardial infarction: A meta‐analysis

Yang

Hong

et al. 2019

Eur J Clin Investigation

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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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Section: Discussionmentioning

confidence: 65%

Predictive value of fragmented QRS for ventricular tachyarrhythmias in patients with acute myocardial infarction: A meta‐analysis

Yang

Hong

et al. 2019

Eur J Clin Investigation

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“…Fragmented QRS (fQRS), which reflects myocardial scarring, has been found to be associated with poor prognostic outcome in several cardiac conditions, including coronary artery disease (Xu et al, 2015), non-ischemic cardiomyopathy (Das et al, 2010), Brugada syndrome (Rattanawong et al, 2017), chronic total occlusion (Bonakdar et al, 2016), and hypertrophic cardiomyopathy (Rattanawong et al, 2018). Recent studies have demonstrated poor prognostic outcome in HFrEF patients whose baseline ECG was positive for fQRS.…”

Section: Introductionmentioning

confidence: 99%

Baseline fragmented QRS is associated with increased all‐cause mortality in heart failure with reduced ejection fraction: A systematic review and meta‐analysis

Kanitsoraphan

Rattanawong

Mekraksakit

et al. 2018

Noninvasive Electrocardiol

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Background: Recent studies suggested that fragmented (fQRS) is associated with poor clinical outcomes in heart failure with reduced ejection fraction (HFrEF) patients. However, no systematic review or meta-analysis has been done. We conducted a systematic review and meta-analysis to assess the association between baseline fQRS and all-cause mortality in HFrEF. Methods:We comprehensively reviewed the databases of MEDLINE and EMBASE from inception to February 2018. Published studies of HFrEF that reported fQRS and outcome of all-cause mortality and major arrhythmic event (sudden cardiac death, sudden cardiac arrest, ventricular fibrillation, or sustained ventricular tachycardia) were included. Data were integrated using the random-effects, generic inverse-variance method of DerSimonian and Laird.Results: Ten studies from 2010 to 2017 were included. Baseline fQRS was associated with increased all-cause mortality (risk ratio [RR] 1.63, 95% confidence interval [CI] 1.22-2.19, p < 0.0001, I 2 = 73%) as well as major arrhythmic events (RR = 1.74, 95% CI 1.09-2.80, I 2 = 89%). Baseline fQRS increased all-cause mortality in both Asian and Caucasian cohorts (RR = 2.17 with 95% CI 1.33-3.55 and RR = 1.45 with 95% CI 1.05-1.99, respectively) as well as increased major arrhythmic events in Asian cohort (RR = 1.50, 95% CI 1.05-2.13). Baseline fQRS also increased all-cause mortality in patients who had not received implantable cardioverter-defibrillator, significantly more than in patients who had received implantable cardioverter-defibrillator

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“…meta-analysis showed that baseline fQRS significantly increased the risk of major arrhythmic events in HCM patients. 16 An observational study showed that a myocardial scar visualized by CMR with LGE predicted major adverse events in HCM patients, 10 but the cost and availability of CMR prevents repetitive testing during long-term follow-up. Thus, more convenient and safer clinical measures to assess cardiac event risks in HCM patients are needed.…”

Section: Discussionmentioning

confidence: 99%

“…10 An association between baseline fQRS and the occurrence of VAEs has also been reported in HCM patients, [11][12][13][14][15] and a recent meta-analysis showed a significant increase in arrhythmic events in HCM patients with baseline fQRS. 16 However, in some HCM patients without baseline fQRS, fQRS newly appears during follow-up, and little is known about the significance of this newly appeared fQRS. In 1 case report, an HCM patient with new appearance of fQRS was reported to have VAEs 7 years after the baseline ECG, 17 but an association between cardiac events and the disc summation method.…”

Section: Ecg Recording and Definition Of Fqrsmentioning

confidence: 99%

New Appearance of Fragmented QRS as a Predictor of Ventricular Arrhythmic Events in Patients With Hypertrophic Cardiomyopathy

Ogura

Nakamura

Morita

et al. 2020

Circ J

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Background: Multiple spikes in the QRS complex (fragmented QRS [fQRS]) on 12-lead electrocardiography have been associated with ventricular arrhythmic events (VAEs) in patients with hypertrophic cardiomyopathy (HCM). The aim of this study was to assess the association between new appearances of fQRS and cardiac events in patients with HCM. Methods and Results:The association between baseline fQRS and cardiac events, namely VAEs, heart failure-related hospitalization, and all-cause death, was evaluated retrospectively in 146 HCM patients (46 patients with fQRS, 100 without fQRS). The median follow-up was 5.3 years. Cardiac events occurred in 29 patients with baseline fQRS and 32 patients without baseline fQRS (63% vs. 32%; P<0.001). VAEs occurred in a significantly larger percentage of patients with than without baseline fQRS (54% vs. 23%, respectively; P<0.001). Of the 100 patients without baseline fQRS, 33 had a new appearance of fQRS during the 4.6-year follow-up, whereas 67 did not. VAEs occurred more frequently in the 33 patients with the appearance of fQRS than in those without (42% vs. 13%, respectively; P=0.001). Multivariable analysis showed that the new appearance of fQRS documented before VAEs was associated with VAEs (hazard ratio 4.29, 95% confidence interval 1.81-10.2; P=0.001). Conclusions:The new appearance of fQRS was associated with an increased risk of VAEs in HCM patients.

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Baseline fragmented QRS increases the risk of major arrhythmic events in hypertrophic cardiomyopathy: Systematic review and meta‐analysis

Abstract: Baseline fQRS increased major arrhythmic events up to sevenfold. Our study suggests that fQRS could be an important tool for risk assessment in patients with HCM.

Cited by 15 publications

References 16 publications

Predictive value of fragmented QRS for ventricular tachyarrhythmias in patients with acute myocardial infarction: A meta‐analysis

Predictive value of fragmented QRS for ventricular tachyarrhythmias in patients with acute myocardial infarction: A meta‐analysis

Baseline fragmented QRS is associated with increased all‐cause mortality in heart failure with reduced ejection fraction: A systematic review and meta‐analysis

New Appearance of Fragmented QRS as a Predictor of Ventricular Arrhythmic Events in Patients With Hypertrophic Cardiomyopathy

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