Clinical Implications of Fragmented QRS Complex as an Outcome Predictor in Children with Idiopathic Dilated Cardiomyopathy

Kong, Younghwa; Song, Jinyoung; Kang, I-Seok; Huh, June

doi:10.1007/s00246-020-02473-1

Cited by 5 publications

(4 citation statements)

References 25 publications

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“…The fragmented QRS group had an older age at diagnosis in both patient groups (dilated cardiomyopathy with and without left ventricular non-compaction). In Kong et al's study 9 , the median age at diagnosis was also reported to be older in the patients with fragmented QRS compared to the non-fragmented QRS group (86.6 and 44.1 months, p = 0.026). In fact, myocardial damage and scar formation in dilated cardiomyopathy patients are increasing over time, the fragmented QRS is manifested as a result of altered myocardial activation due to fibrosis and scar repair.…”

Section: Discussionmentioning

confidence: 84%

“…In this study, we found that the presence of fragmented QRS strongly predicted major adverse cardiac event and/or cardiac death. Similarly, in a retrospective study of 63 paediatric patients with idiopathic dilated cardiomyopathy in Korea between 2003 and 2014, the positive fragmented QRS complex was reported as a strong predictor for adverse outcomes 9 . In the study includes 842 patients over 20 years old with left ventricle dysfunction, the presence of fragmented QRS was not found related with poor outcomes or death caused arrhythmia.…”

Section: Discussionmentioning

confidence: 91%

“…[6][7][8] However, studies in children are scarce. 9,10 Furthermore, there has been no research on dilated cardiomyopathy with left ventricular non-compaction in children. We hypothesised that fragmented QRS would be more frequent in patients with left ventricular non-compaction because of their peculiar myocardial architecture.…”

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confidence: 99%

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The impact of fragmented QRS on clinical findings and outcomes in children with dilated cardiomyopathy with or without left ventricular non-compaction

Bayram,

Ramoğlu,

Karagözlü

et al. 2023

Cardiol Young

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Objective: The aim of this study is to investigate the frequency of fragmented QRS and its associations with clinical findings and prognosis in children diagnosed with dilated cardiomyopathy with or without left ventricular non-compaction. Methods: This retrospective study was conducted between 2010 and 2020. Patients with dilated cardiomyopathy were classified into two groups according to the presence of left ventricular non-compaction: Dilated cardiomyopathy with left ventricular non-compaction and dilated cardiomyopathy without left ventricular non-compaction. Patients were also divided into two groups according to the presence of fragmented QRS (fragmented QRS group and non-fragmented QRS group). Results: Twenty-three of 44 patients (52.3%) were male. Among left ventricular non-compaction patients, the fragmented QRS group had more complex ventricular arrhythmias (p = 0.003). Patients with fragmented QRS had a significantly higher rate of major adverse cardiac events and/or cardiac death in both cardiomyopathy groups (p = 0.003 and p = 0.005). However, the rate of major adverse cardiac events and/or cardiac death was similar between dilated cardiomyopathy patients with and without left ventricular non-compaction. Multivariate logistic regression analysis showed that the presence of fragmented QRS strongly predicts major adverse cardiac events and/or cardiac death (odds ratio, 31.186; 95% confidence interval, 2.347–414.307). Although the survival rates between cardiomyopathy groups were similar, patients with fragmented QRS had a markedly lower survival rate during the follow-up period, as mean of 15 months (p = 0.001). Conclusion: Our study showed that the presence of fragmented QRS may be an important ECG sign predicting an major adverse cardiac event and/or cardiac death in patients with dilated cardiomyopathy. We believe that recognising fragmented QRS could be valuable in forecasting patient prognosis and identifying high-risk patients who require additional support.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 91%

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The impact of fragmented QRS on clinical findings and outcomes in children with dilated cardiomyopathy with or without left ventricular non-compaction

Bayram,

Ramoğlu,

Karagözlü

et al. 2023

Cardiol Young

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“…Fragmented QRS may predict adverse outcomes such as severe arrhythmia, SCD, and HF, and associated with LV dyssynchrony in idiopathic DCM patients and can be used as a reliable ECG marker for evaluating left ventricular dyssynchrony and predicting prognosis in patients with idiopathic DCM ( 34 ). Kong et al ( 35 ) divided 63 children (31.2 ± 74.2 months) with IDCM into the non-fQRS group ( n = 38) and fQRS group ( n = 25); the study found that the LVEF of the fQRS group was lower than that of the non-fQRS group (23.9% ± 8.3% vs. 29.9% ± 10.5%, P < 0.05), the QRSd was also prolonged (98.8 ± 27.0 ms vs. 80.6 ± 20.2 ms, P < 0.01), and the incidence of arrhythmias was higher (36.0% vs. 7.9%, P < 0.01), suggesting that the positive fQRS complex in children with DCM was identified as risk factors for adverse outcomes. Besides, the age of fQRS group was significantly older at diagnosis (86.6 months vs. 44.1 months, P < 0.05).…”

Section: Qrs Wavementioning

confidence: 99%

Predictive value of electrocardiographic markers in children with dilated cardiomyopathy

Wang

et al. 2022

Front. Pediatr.

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Dilated cardiomyopathy (DCM) refers to a heterogeneous group of cardiomyopathies characterized by ventricular dilatation and myocardial systolic dysfunction, which can lead to serious consequences such as malign arrhythmia, sudden death, heart failure, and thromboembolism. With its economical, non-invasive, simple and reproducible advantages, electrocardiogram (ECG) has become an important indicator for assessing the prognosis of cardiovascular diseases. In recent years, more and more studies of electrocardiography on DCM have been carried out, but there is still a lack of a comprehensive summary of its prognostic value. This article reviews the prognostic value of electrocardiographic markers in children with DCM.

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The Neonatal QRS Complex and Its Association with Left Ventricular Mass

Molin,

Hartmann,

Pærregaard

et al. 2023

Pediatr Cardiol

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To evaluate QRS complex features during the first month of life and the association with echocardiographic measurements of left ventricular mass in neonates. Prospective cohort study of neonates with electrocardiography (ECG) and echocardiography performed during the first month of life. Left ventricular mass index (LVMI) was determined by echocardiography and the correlation with electrocardiographic markers of LVMI outliers (≥ 98th percentile) were analyzed. We included 17,450 neonates (52% boys; median age at examination 11 days) and found an increase in median QRS duration and LVMI during the first month of life (54 vs. 56 ms and 24.7 vs. 28.6 g/m2 at days 0–4 and 25–30, respectively; both p < 0.001). All investigated ECG features (QRS duration, QRS area in V1/V6, maximum amplitudes of S-V1/R-V6, and the Sokolow–Lyon voltage product) showed no to low correlation with LVMI, resulting in low sensitivities (0–9.0%), but high specificities (97.2–98.1%), and area under the curve values close to the identity line (0.49–0.61) for identifying LVMI outliers. Adjustment of outlier definition for LVMI and threshold for QRS features had no significant effect on sensitivity. We present reference values for QRS complex features and their association with LVMI in neonates from a large, unselected, population-based cohort. The QRS complex gradually evolved during the first month of life but had a low correlation with LVMI. Our results indicate a poor diagnostic value of using ECG features to identify LVMI outliers in neonates.Trial Registry Copenhagen Baby Heart, NCT02753348, https://clinicaltri-als.gov/ct2/show/NCT02753348?cond=Copenhagen+Baby+Heart&draw=2&rank=1, deidentified individual participant data will not be made available.

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Clinical Implications of Fragmented QRS Complex as an Outcome Predictor in Children with Idiopathic Dilated Cardiomyopathy

Cited by 5 publications

References 25 publications

The impact of fragmented QRS on clinical findings and outcomes in children with dilated cardiomyopathy with or without left ventricular non-compaction

The impact of fragmented QRS on clinical findings and outcomes in children with dilated cardiomyopathy with or without left ventricular non-compaction

Predictive value of electrocardiographic markers in children with dilated cardiomyopathy

The Neonatal QRS Complex and Its Association with Left Ventricular Mass

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