Fragmented QRS Is a Novel Risk Factor for Ventricular Arrhythmic Events After Receiving Cardiac Resynchronization Therapy in Nonischemic Cardiomyopathy

Igarashi, Miyako; Tada, Hiroshi; Yamasaki, Hiro; Kuroki, Kenji; Ishizu, Tomoko; Seo, Yoshihiro; Machino, Takeshi; Murakoshi, Nobuyuki; Sekiguchi, Yukio; Noguchi, Yuichi; Nogami, Akihiko; Aonuma, Kazutaka

doi:10.1111/jce.13139

Cited by 13 publications

(21 citation statements)

References 25 publications

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“…The presence of fQRS in HCM patients could predict a higher risk of all-cause mortality, a higher risk of cardiovascular disease mortality, and a higher risk of heart failure-related deaths. In a study performed by (Igarashi et al, [25], they found that fQRS was an independent risk factor for developing ventricular arrhythmias and sudden cardiac death in patients with non-ischemic cardiomyopathy treated with cardiac resynchronization. In a recently published study by (Attachaipanich and Krittayaphong,[26], they studied the value of fQRS in predicting in-hospital life-threatening arrhythmic complications in after STEMI.…”

Section: Discussionmentioning

confidence: 99%

Fragmented QRS Complex as a Predictor of High Risk in Acute Coronary Syndrome

Radwan¹,

Mansour²,

Al-Daydamony³

et al. 2019

CCR

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Background: To detect the potential in hospital prognostic value of fQRS complex in patients with acute coronary syndrome (ACS) & investigate whether FQRS complex can be used to distinguish patients with early NSTEMI from those with unstable angina. Methods: It included 150 patients with acute NSTEMI and unstable angina. All patients were subjected to Grace score calculation, ECG to detect ischemic changes and detect presence or absent of fQRS, transthoracic echo to detect LV ejection fraction and recording in-hospital outcome. Results: Patients with fQRS have significant higher Killip class>2, higher troponin &CKMB levels, higher grace score, increased LVEDD & LVESD and significantly lower LVEF%. LVEF is significantly lower among patients with fQRS than patients with not fQRS in NSTEMI patients while there is no significant difference of LVEF % between both groups in unstable angina patients. There is significant association between fQRS and higher prevalence of NSTEMI and higher incidence of heart failure, arrhythmia and bad outcome. By multivariate analysis, NSTEMI (p =0.003) and high HR (p =0.004) and fragmented QRS (p =0.00) were the only significant predictors for bad outcome. FQRS have the ability to diagnose NSTEMI in 47.9% of cases, fQRs can truly exclude NSTEMI in 72.7% of case. Conclusion: Among patients with ACS, the presence of fQRS was associated with an increase incidence of complication, worse outcome, larger LV dimensions, and lower LVEF. The presence of fQRS in acute coronary syndrome patients could predict the presence of NSTEMI with fair diagnostic value.

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Section: Discussionmentioning

confidence: 99%

Fragmented QRS Complex as a Predictor of High Risk in Acute Coronary Syndrome

Radwan¹,

Mansour²,

Al-Daydamony³

et al. 2019

CCR

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“…Compared with other techniques focused on the time or frequency domain, we consider that the wavelet transform may provide significant advantages. Although firstly reported, the analysis of QRS fragmentation on the time domain may be less useful than the analysis of the high-frequency content to detect patients at risk for SCD [ 2 , 8 , 9 ]. The main limitation of the analysis of fragmentation is that it is based on a subjective classification, with no absolute measurements, and thus it is more difficult to standardize.…”

Section: Discussionmentioning

confidence: 99%

“…In previous studies, the physiological basis of fragmentation has been related to delays in conduction of the electrical wavefronts through the myocardium, mostly secondary to the interposition of scar and fibrotic tissue [ 4 , 5 ]. The latter mechanism also explain the late potentials usually recorded from the myocardium of patients with ischemic cardiomyopathy [ 6 , 7 ] and other clinical entities with a high risk of SCD such as Hypertrophic Cardiomyopathy [ 8 ] or Dilated Cardiomyopathy [ 9 ]. The Brugada Syndrome (BrS) [ 10 , 11 ] is a particular case in which functional mechanisms promoting delayed conduction explain the occurrence of delay/late potentials in the absence of fibrotic tissue [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Analysis of the High-Frequency Content in Human QRS Complexes by the Continuous Wavelet Transform: An Automatized Analysis for the Prediction of Sudden Cardiac Death

Iglesias

Gutiérrez

Cos

et al. 2018

Sensors

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Background: Fragmentation and delayed potentials in the QRS signal of patients have been postulated as risk markers for Sudden Cardiac Death (SCD). The analysis of the high-frequency spectral content may be useful for quantification. Methods: Forty-two consecutive patients with prior history of SCD or malignant arrhythmias (patients) where compared with 120 healthy individuals (controls). The QRS complexes were extracted with a modified Pan-Tompkins algorithm and processed with the Continuous Wavelet Transform to analyze the high-frequency content (85–130 Hz). Results: Overall, the power of the high-frequency content was higher in patients compared with controls (170.9 vs. 47.3 103nV2Hz−1; p = 0.007), with a prolonged time to reach the maximal power (68.9 vs. 64.8 ms; p = 0.002). An analysis of the signal intensity (instantaneous average of cumulative power), revealed a distinct function between patients and controls. The total intensity was higher in patients compared with controls (137.1 vs. 39 103nV2Hz−1s−1; p = 0.001) and the time to reach the maximal intensity was also prolonged (88.7 vs. 82.1 ms; p < 0.001). Discussion: The high-frequency content of the QRS complexes was distinct between patients at risk of SCD and healthy controls. The wavelet transform is an efficient tool for spectral analysis of the QRS complexes that may contribute to stratification of risk.

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“…Although meaningful clinical usage of Tp-Te for prospective risk stratification for VA events and mortality in patients with cardiomyopathy has been demonstrated before, further risk stratification within three separate high-risk population with HF would be of clinical value [4]. Fragmented QRS (fQRS) is another risk predictor index on surface ECG for electro-mechanical dyssynchrony, VA, SCD and poor prognosis for patients with HF and hypertrophic cardiomyopathy [17], [18], [19], [20], [21], [22]. The purpose of this study was to assess If there is a distinction of various indices of TDR in three group of patients with HF (HFrEF- HfmrEF- HFpEF) and there is a relationship between fQRS and these indices in patients with HF.…”

Section: Introductionmentioning

confidence: 99%

A Comparing of Tp-Te Interval and Tp-Te/Qt Ratio in Patients with Preserved, Mid-Range and Reduced Ejection Fraction Heart Failure

Son¹,

Boduroğlu²

2019

Open Access Maced J Med Sci

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BACKGROUND: Heart failure (HF) is classified in three class: HF with preserved EF (HFpEF); normal or LVEF ≥ 50%, HF with reduced EF (HFrEF); LEVF < 40% and newly HF mid-range EF (HFmrEF); LVEF 40-49%. On Electrocardiography (ECG) T wave, Tpeak-Tend (Tp-Te) interval reflects transmural dispersion of repolarisation (TDR) which of these indexes have been proposed as predictors of risk for ventricular arrhythmia (VA) in many cardiac diseases. AIM: Aim of this study to asses these indices of TDR among three HF class. METHODS: Total of 192 patients were included in this study. RESULTS: Many of indices like Tp-Te, Tp-Te/QT wasn’t different between groups (P > 0.05). But mean Q-Tpeak (QTp), S-Tend (S-Te) and S-Tpeak (S-Tp) were found significantly different between groups (P < 0.05). Again S-Te was found different according to having fragmented QRS (fQRS) on ECG (P = 0.031). Comparing to mitral inflow E/A parameters showed significant differences for Tp-Te, Tp-Tec, Tp-Te/QT, Tp-Te/QTc and Tp-Tec/QTc parameters. Finally, we found correlations between S-Te and white blood cell (WBC) (r = - 0.171; P = 0.037) and S-Tp and WBC (r = - 0.170; P = 0.038) and between S-Te and fQRS (r = 0.158; P = 0.031). CONCLUSIONS: We didn’t find differences for many of indices of TDR like Tp-Te interval between groups except QTp, S-Te, S-Tp intervals. Also, S-Te and fQRS showed significant correlation. For prediction of ventricular arrhythmia and cardiovascular death newer indexes on ECG are needed to be established in the future which will make us facilitate to distinguish high risk patients.

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Fragmented QRS Is a Novel Risk Factor for Ventricular Arrhythmic Events After Receiving Cardiac Resynchronization Therapy in Nonischemic Cardiomyopathy

Abstract: In patients with nonischemic cardiomyopathy who received CRT, an fQRS-post was independently associated with SCD or ventricular arrhythmic events.

Cited by 13 publications

References 25 publications

Fragmented QRS Complex as a Predictor of High Risk in Acute Coronary Syndrome

Fragmented QRS Complex as a Predictor of High Risk in Acute Coronary Syndrome

Analysis of the High-Frequency Content in Human QRS Complexes by the Continuous Wavelet Transform: An Automatized Analysis for the Prediction of Sudden Cardiac Death

A Comparing of Tp-Te Interval and Tp-Te/Qt Ratio in Patients with Preserved, Mid-Range and Reduced Ejection Fraction Heart Failure

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