Diagnostic value of fragmented QRS complex in myocardial scar detection: systematic review and meta-analysis of the literature

Abstract

A b s t r a c t Background and aim:The present study aimed to investigate the diagnostic value of fragmented QRS complex (fQRS) on 12-lead electrocardiogram (ECG) for myocardial scar detection, and presented the results in a systematic review and meta-analysis format.Methods: Medline, SCOPUS, and ISI Web of Knowledge were searched electronically with "Fragmented QRS" or "fQRS" as key words. All related studies that had evaluated the accuracy of fQRS for myocardial scar diagnosis were included.Results: Eight studies (2560 patients) were finally included in the systematic review. Specificity assessment could be evaluated only by five out of these eight articles. Overall pooled sensitivity of fQRS, Q wave, and mixed Q-fQRS was 68% (65-71), 51% (47-55), and 74% (69-79) and the pooled specificity was 80% (79-81), 97% (97-98) and 92% (91-93), respectively. Conclusions:Fragmented QRS is a novel ECG marker with more sensitivity and less specificity than Q wave. A combination of fQRS with Q wave in a 12-lead ECG results in up to 74% sensitivity and 92% specificity. Additional studies are needed to assess the significance of this ECG parameter for regional myocardial scar detection.

Fragmented QRS as an early predictor of left ventricular systolic dysfunction in healthy individuals: a nested case-control study in the era of speckle tracking echocardiography

“…For example, although pathologic Q-wave is known as the marker of myocardial infarction (MI) on a 12-lead EKG, its capacity in detecting myocardial scars is confined to only about one third of patients with documented MI [9,10]. It has been suggested that fQRS is more sensitive than Q-wave for identifying myocardial scars [11]. Also, an association between fQRS and regional and global LV dysfunction has been reported in patients with coronary artery disease (CAD).…”

Fragmented QRS complex in patients with systemic lupus erythematosus at the time of diagnosis and its relationship with disease activity

“…The mean age was 39.5 years, and 37 (84.1%) of the participants were women. The median SLEDAI-2K was 13.5 (IQR, [10][11][12][13][14][15][16][17][18][19][20], and the median period from the estimated date of onset to the date of diagnosis was 3 months (IQR, 2-15). Twenty-six patients (59.1%) had fQRS at the time of diagnosis, 18 patients were followed, and 6 patients (33.3%) disappeared fQRS after immunosuppressive therapy.…”

“…The fQRS may be caused by zigzag conductions around the myocardium previously scarred by ischemia or inflammation [12]. It is useful for identifying myocardial scars such as those resulting from CAD and cardiac sarcoidosis, for identifying high-risk patients with various cardiac diseases, and for predicting sudden cardiac death in the general population [11,[13][14][15][16][17]. The prevalence of fQRS appears to be higher in patients with rheumatic diseases, such as rheumatoid arthritis (RA), systemic sclerosis (SSc), ankylosing spondylitis, and Behçet's disease, than in controls, and similar findings have been reported in patients with SLE [18][19][20][21][22].…”

The relation between coronary artery disease severity and fragmented QRS complex in patients with left bundle branch block

“…In previous studies, the presence of fQRS was found to be useful in detection of myocardial scar, 7 and in prediction of myocardial infarction and reperfusion parameters. 8 However, these studies were designed for fQRS in patients with narrow QRS.…”