Prognostic Significance of Fragmented QRS in Patients with Hypertrophic Cardiomyopathy

Abstract

Objectives: The relationship between a fragmented QRS (fQRS) and clinical outcomes in patients with hypertrophic cardiomyopathy (HCM) remains unclear.This study aimed to investigate the prognostic significance of fQRS in patients with HCM. Methods: Between 2000 and 2012, 326 unrelated patients with HCM (72% male with a mean age of 52 years) were included and were divided into 2 groups: those with fQRS and those without fQRS. Results: A total of 105/326(32.2%) patients with HCM presented with fQRS at enrollment. During a follow-up of 5.3 ± 2.4 years, 33 patients died, 30 of cardiovascular disease (CVD). Cox regression analysis revealed that fQRS predicted a higher risk of all-cause mortality (adjusted hazard ratio [HR] 2.24; 95% confidence interval [CI] 1.08-4.64; p = 0.030) and CVD mortality (adjusted HR 2.68; 95% CI 1.22-5.91; p = 0.014). Our study also showed that fQRS increased the risk of heart failure-related death (adjusted HR 3.75; 95% CI 1.24-11.30; p = 0.019). Conclusions: Our results indicate that fQRS is associated with adverse clinical outcomes in patients with HCM.

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

“…Identifying those who would benefit from an ICD is challenging but The importance of fQRS, which is suggestive of myocardial scarring and fibrosis, has been increasingly supported by recent studies of MAE in various cardiac diseases (Das et al, 2006;Konno et al, 2015;Lu et al, 2017;Sha et al, 2011;Take & Morita, 2012), including HCM (Debonnaire et al, 2015;Konno et al, 2015;Lu et al, 2017). Fibrosis or tissue heterogeneity increases susceptibility to reentry and arrhythmias.…”

“…Potentially relevant articles identified from search of MEDLINE (n = 7) and EMBASE database (n = 8) and screened for retrieval Title and abstract review of potentially relevant articles (n = 12) 1 article was excluded at this stage because of abstract presented Exclusion of 3 duplications 11 articles underwent full-length article review 6 articles were excluded at this stage as they were -1 case report -2 no outcome of interest -1 conducted in non-hypertrophic cardiomyopathy -2 review article 5 articles underwent meta-analysis The importance of fQRS, which is suggestive of myocardial scarring and fibrosis, has been increasingly supported by recent studies of MAE in various cardiac diseases (Das et al, 2006;Konno et al, 2015;Lu et al, 2017;Sha et al, 2011;Take & Morita, 2012), including HCM (Debonnaire et al, 2015;Konno et al, 2015;Lu et al, 2017). Fibrosis or tissue heterogeneity increases susceptibility to reentry and arrhythmias.…”

“…Given the published outcomes available for study, we did not take overall mortality or total cardiovascular mortality into account. However, the recent study from Lu et al (2017) Favors non-fragmented QRS Favors fragmented QRS Heterogeneity chi-squared = 3.20 (d.f. = 4) Estimate of between-study variance Tau-squared = 0.00 Test for overall effect: z = 6.48 (p = .000) F I G U R E 3 Funnel plot of fragmented QRS and major arrhythmic events.…”

“…However, the recent study from Lu et al (2017) shows that fQRS is associated with increased all-cause mortality, cardiovascular disease mortality, and heart failure related death. First, all of the studies included were cohorts which are observational in nature.…”

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

“…Various studies had shown that the presence of fQRS was found to be predictor for bad outcome. In a study by (Lu et al, [24] they studied the prognostic effect of fQRS in patients with hypertrophic cardiomyopathy (HCM). They have found that the presence of fQRS in this group of patients was associated with an adverse outcome.…”