QRS Fragmentation in Preserved Ejection Fraction Heart Failure: Functional Insights, Pathological Correlates, and Prognosis

Sung, Kuo‐Tzu; Chang, Sheng-Hsiung; Chi, Po-Ching; Chien, Shih‐Chieh; Lo, Chi‐In; Lin, Chao‐Feng; Huang, Wen‐Hung; Yun, Chun‐Ho; Tsai, Cheng‐Ting; Su, Cheng‐Huang; Hou, Charles Jia‐Yin; Yeh, Hung‐I; Tsao, Chin-Ho; Kuo, Jen‐Yuan; Hung, Chung‐Lieh

doi:10.1161/jaha.122.028105

Cited by 2 publications

(1 citation statement)

References 31 publications

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“…Only lateral fQRS was associated with a higher risk of all‐cause mortality, arrhythmia, and cardiogenic death (Terho et al., 2014 ). Another study in heart failure patients with preserved ejection fraction showed that both inferior and anterior/lateral fQRS were associated with a higher‐risk cardiovascular and all‐cause mortality (Sung et al., 2023 ). The prognostic value of fQRS in cancer populations will be the subject of further investigation.…”

Section: Discussionmentioning

confidence: 99%

Electrocardiographic characteristics of bladder cancer patients receiving preoperative chemotherapy combined with immunotherapy

Chen,

Jia,

Zheng

et al. 2024

Noninvasive Electrocardiol

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ObjectivePatients treated with preoperative chemotherapy and immunotherapy for bladder cancer may be at increased risk of cardiotoxicity and electrophysiological abnormalities. This study aimed to analyze their electrocardiographic (ECG) alterations.MethodsPatients with bladder cancer who were hospitalized and receiving tislelizumab plus nab‐paclitaxel (TnP) were enrolled prospectively. ECG, cardiac biomarkers, and echocardiography were performed at baseline and the end of TnP.ResultsA total of 60 patients (76.7% males), including 30 muscle‐invasive and 30 non‐muscle‐invasive bladder cancer, received three or four cycles of TnP, respectively. Hypertension was the commonest comorbidity (41.7%), and 25 patients (41.7%) were prescribed cardiovascular drugs. In comparison with baseline characteristics, cardiac troponin I (cTnI) and N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) were within normal ranges after TnP. However, echocardiographic parameter of left ventricular ejection fraction slightly decreased after TnP (62.81 ± 3.81% to 61.10 ± 4.37%, p = .011). The incidence of abnormal ECG increased from 65.0% at baseline to 76.7%, of which only a higher prevalence of fragmented QRS (fQRS) was observed (33.3% to 50.0%, p = .013; mainly in inferior leads). ECG parameters of QT dispersion (QTd) were prolonged significantly after the regimen (39.50 ± 11.37 to 44.20 ± 15.85 ms, p = .019).ConclusionIn bladder cancer patients receiving preoperative chemotherapy combined with immunotherapy, the main ECG abnormality was fQRS and QTd, with relatively normal cardiac biomarkers and echocardiographic parameters. Regular ECG screening should be carried out carefully to detect potential cardiotoxicity in the long‐term follow‐up.

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Section: Discussionmentioning

confidence: 99%

Electrocardiographic characteristics of bladder cancer patients receiving preoperative chemotherapy combined with immunotherapy

Chen,

Jia,

Zheng

et al. 2024

Noninvasive Electrocardiol

View full text Add to dashboard Cite

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Fragmented QRS complex could predict all-cause mortality in patients with connective tissue disease–associated pulmonary arterial hypertension

Dai,

Liu,

Zhang

et al. 2024

Rheumatology

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Objectives To investigate the prognostic impact and pathophysiological characteristics of fragmented QRS complex (fQRS) on patients with connective tissue disease-associated pulmonary arterial hypertension (CTD-PAH). Methods This was a multicentre retrospective study recruiting 141 patients with CTD-PAH diagnosed by right heart catheterization (114 cases in the discovery cohort and 27 cases in the validation cohort). fQRS and ST-T change were detected on conventional 12-lead electrocardiogram (ECG). Patients were followed up every 3 months to update their status and the primary end point was all-cause death. Clinical information and ECG characteristics were compared between survival and death groups and Kaplan-Meier curve was used for survival analysis. Results There were significant differences in age, gender, 6-min walk distance, NT-proBNP, WHO class, presence of fQRS and presence of ST-T change in inferior leads between survival group and death group. Inferior fQRS and ST-T change were significantly associated with right ventricular (RV) dilatation and reduced RV ejection fraction (RVEF). Kaplan-Meier curve showed that all-cause mortality was higher in CTD-PAH with fQRS (p= 0.003) and inferior ST-T change (p= 0.012). Low- and intermediate-risk CTD-PAH with inferior ST-T change had higher all-cause mortality (p= 0.005). The prognostic value of fQRS and inferior ST-T change was validated in external validation cohort. Conclusion The presence of inferior fQRS and ST-T change could predict poor prognosis in CTD-PAH. Clinical trial registration number NCT05980728, https://clinicaltrials.gov

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QRS Fragmentation in Preserved Ejection Fraction Heart Failure: Functional Insights, Pathological Correlates, and Prognosis

Cited by 2 publications

References 31 publications

Electrocardiographic characteristics of bladder cancer patients receiving preoperative chemotherapy combined with immunotherapy

Electrocardiographic characteristics of bladder cancer patients receiving preoperative chemotherapy combined with immunotherapy

Fragmented QRS complex could predict all-cause mortality in patients with connective tissue disease–associated pulmonary arterial hypertension

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