Fragmented QRS complex frequency and location as predictor of cardiogenic shock and mortality following acute coronary syndrome

Abstract

Background: Worldwide, coronary heart disease (CHD) is topping the foremost important chief causes of mortality. Fragmented QRS (f-QRS) is a pattern of QRS complex in 12 leads surface ECG which showed a promising value in predicting the outcome in cardiac diseases including ischemic heart disease. We aimed to research the importance of using f-QRS as a non-invasive and cheap tool for the prediction of cardiogenic shock and mortality in acute coronary syndrome (ACS). Methods: A retrospective study includes eighty four critically ill ACS patients. Patients were classified consistent with the presence or absence of fragmented QRS into two groups (46 and 38 patients respectively). Exclusion criteria include past history of important ischemic events (MI, PCI, and CABG), permanent AF, and/or cardiomyopathy. No statistical significant differences were detected between the 2 groups as regards the age, gender, major risk factors of ischemic heart condition, cardiac bio-markers, Killip class, LVEF, updated GRACE risk score of ACS, and inhospital mortality. Results: A number value of f-QRS leads > 3 yields sensitivity and specificity (83.3% and 72.5% respectively) for predicting hospital mortality. The f-QRS group was further split-up according to the numbers of f-QRS leads into 2 subgroups; subgroup (A1) including patients with > 3 f-QRS leads and subgroup (A2) including patients ≤ 3 f-QRS leads. Subgroup (A2) showed considerable difference as regards some important variables including a higher SBP (P = 0.016), a slower HR (P = 0.014), a lower updated GRACE risk score (3.22 ± 6.95 vs 6.81 ± 12, P value 0.048), and a lower rate of hospital death (1/30 vs. 5/16, P = 0.015). Anterior f-QRS showed statistically significant higher HR, lower SBP, a higher frequency of shock, a higher updated GRACE risk score, and a higher chance of in-hospital mortality (P = 0.004) compared to non-anterior f-QRS. Conclusion: The position and number of f-QRS leads provide a non-invasive and a readily accessible tool to predict the prognosis, occurrence of cardiogenic shock, and in-hospital mortality.

Fragmented QRS is a marker of mortality in patients with severe COVID-19: A retrospective observational study

“…In a study, the presence of 3 f-QRS leads was identified as an independent predictor of cardiac death or hospitalization for heart failure in patients with prior myocardial infarction (44). In another study, f-QRS in anterior leads was found to be associated with higher GRACE risk score and Killip class (45). In our study, the lead with f-QRS cut-off value was found to be ≥2.…”

Determination of Vitamin K2, Lipoprotein (a) and N-Terminal pro Brain Natriuretic Biomarkers in Diabetic Hypertensive Patients with Acute Myocardial Infarction for Clinical Intervention

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Fragmented QRS Is Independently Predictive of Long-Term Adverse Clinical Outcomes in Asian Patients Hospitalized for Heart Failure: A Retrospective Cohort Study

“…The presence of fQRS has been shown to be predictive of all-cause mortality and ventricular arrhythmia (VA) ( 4 ), and several morphological criteria and classification systems have been set forth by a number of research groups, including those by Das et al and Haukilahti et al ( 2 , 5 ). While fQRS has been shown to be predictive of adverse cardiovascular outcomes in patients with heart failure ( 4 ), most studies have focused on either acute outcomes of hospitalized patients, or long-term outcomes of ambulatory patients ( 6 , 7 ). With the rising prevalence of heart failure in Asia ( 8 , 9 ), there is an ever greater need for good prognostic markers in Asian patients with heart failure.…”