QRS fragmentation in children with suspected myocarditis: a possible additional diagnostic sign

Ferrero, Paolo; Piazza, Isabelle

doi:10.1017/s1047951120001262

Cited by 7 publications

(3 citation statements)

References 19 publications

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“…We have previously described the reproducibility of fragmented QRS as a complementary diagnostic sign in patients with proven AM in adult and pediatric populations [ 21 , 22 , 23 ]. This observation stemmed from the hypothesis that pathological changes in myocardium of patients with AM might translate into anisotropic conduction expressed as fQRS in one or more leads.…”

Section: Introductionmentioning

confidence: 99%

Early Diagnosis of Acute Myocarditis in the ED: Proposal of a New ECG-Based Protocol

et al. 2022

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The diagnosis of acute myocarditis (AM) is based on a multi-parametric assessment including clinical presentation, ECG, imaging and biomarkers. Fragmented QRS (fQRS) might be an additional diagnostic sign in patients with proven AM. The main objective of this study was to assess the diagnostic yield of fQRS in patients with suspected AM presenting to the emergency department (ED). Patients admitted between January 2016 and March 2021 with a proven diagnosis of AM, according to clinical, cardiac magnetic resonance (CMR) and/or histologic criteria, were included in the analysis. In total, 51 patients were analyzed (41 men, 78%), with a median age of 36 (29–45) years. Thirty-three (65%) patients had prodromal flu-like symptoms. Patients presented to the ED mostly complaining of chest pain (68%) and palpitations (21%). Seven (14%) patients experienced cardiac arrest, one of whom died. At presentation, 40 patients (78%) displayed fQRS, and 10 (20%) presented ventricular arrhythmias. All the surviving patients underwent CMR and displayed late gadolinium enhancement (LGE). ECG leads showed that fQRS matched the LGE distribution in 38 patients (95%). The presence of fQRS is a simple clinical bedside tool to support the initial suspect of AM in the emergency department and to guide the most appropriate clinical workup.

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Section: Introductionmentioning

confidence: 99%

Early Diagnosis of Acute Myocarditis in the ED: Proposal of a New ECG-Based Protocol

et al. 2022

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“…[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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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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“…Electrocardiogram recorded the following days showed QRS fragmentation and voltage reduction in V1–V2 ( Figure 2 ), consistent with myocardial oedema and fibrosis. 3 …”

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confidence: 99%

QRS fragmentation in children with suspected myocarditis: a possible additional diagnostic sign

Cited by 7 publications

References 19 publications

Early Diagnosis of Acute Myocarditis in the ED: Proposal of a New ECG-Based Protocol

Early Diagnosis of Acute Myocarditis in the ED: Proposal of a New ECG-Based Protocol

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

Brugada-like pattern and myocarditis in a child with multisystem inflammatory syndrome: overlap or differential diagnosis?

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