Relationship between Fragmented QRS Complex and Aortic Stiffness in Chronic Hemodialysis Patients

Abstract

Objective: This study aimed to evaluate the correlation between fragmented QRS complex (fQRS), aortic stiffness, and diastolic dysfunction in hemodialysis patients. Subjects and Methods: A sample of 56 patients who received hemodialysis treatment was stratified into 2 groups according to their electrocardiography (ECG) patterns with or without fQRS. Baseline characteristics and laboratory parameters of patients were documented. Conventional echocardiographic and Doppler echocardiographic procedures were performed in all patients. The mean early (Em) diastolic and late (Am) diastolic myocardial velocities were calculated. These tests were performed before dialysis. The Student t test, Mann-Whitney U test, χ² test, Spearman correlation, and multivariate linear regression analysis were used to analyze parameters where appropriate. Results: Of the 56 patients under hemodialysis, fQRS in ECG was detected in 26 (46.4%). Echocardiographic evaluation showed that deceleration time (237.57 ± 40.10 ms; p = 0.030), isovolumic relaxation time (126.84 ± 15.62 ms; p < 0.001), early (E)/late (A) ventricular filling velocity (E/A) ratio (1.15 ± 0.40; p ≤ 0.001), and aortic stiffness index value (9.62 ± 4.53; p = 0.016) exhibited a statistical increase in hemodialysis patients with fQRS compared to patients without fQRS. E (58.23 ± 19.96 m/s; p = 0.004), and Em (5.96 ± 2.08 cm/s; p = 0.023) velocity levels were significantly lower in hemodialysis patients with fQRS than patients without fQRS. Aortic stiffness closely correlated with diastolic dysfunction (deceleration time r = 0.273, p = 0.042; isovolumic relaxation time r = 0.497, p < 0.001; E/A ratio r = -0.449, p = 0.001). On multivariate linear regression analysis, fQRS and aortic stiffness were independently associated in hemodialysis patients (β = 0.321, p = 0.049). Conclusions: Increased aortic stiffness and left ventricular systolic dysfunction were observed more frequently in hemodialysis patients with fQRS than in patients without fQRS. fQRS is an important determinant of aortic stiffness in hemodialysis patients.

Fragmented QRS as a predictor of subclinical cardiovascular disease in patients with chronic kidney disease

“…17 There are two studies investigating the relationship between fQRS and CVD in patients with CKD. 9,18 Adar et al have investigated the relation of fQRS with left ventricular dysfunction in different stages of CKD. 9 The study consisted of 82 CKD patients with normal ejection fraction.…”

Blood Pressure and Age Are the Main Determinants of Aortic Stiffness

“…We would like to thank Gülgün for his interest in our paper entitled "Relationship between Fragmented QRS Complex and Aortic Stiffness in Chronic Hemodialysis Patients" [1] . He pointed out that, as one of the important determinants of aortic stiffness, BMI should have been checked in the study population.…”

Aortic Stiffness May Be Affected by Body Mass Index

“…Ferreira et al [5] reported that the mean BMI was higher in subjects with stiffer arteries than those with less stiff arteries based on a longitudinal study, hence their conclusion that blood pressure and the central pattern of body fatness were considerable factors influencing arterial stiffness. However, Güçlü et al [1] did not provide any data regarding BMI in the studied population. Their study would have been more reliable if they had reported that there was no significant difference in BMI between the hemodialysis patients with and without fQRS.…”

“…giotensin-converting enzyme inhibitors, and angiotensin receptor blockers [1][2][3][4][5] . However, several other factors could have some effect on arterial stiffness.…”

“…Dear Editor, I read with great interest the study by Güçlü et al [1] entitled "Relationship between Fragmented QRS Complex and Aortic Stiffness in Chronic Hemodialysis Patients,'' in which they reported a higher level of aortic stiffness and left ventricular systolic dysfunction in hemodialysis patients with fragmented QRS complex (fQRS) than those without fQRS. I congratulate the authors on their valuable study.…”