Role of QRS fragmentation in 12-lead surface ECG in prediction of isolated epicardial coronary artery ectasia and its anatomical distribution in patients without acute coronary syndromes

Abstract

Background: Coronary artery ectasia (CAE) is a form of abnormal coronary artery lumen dilatation associated with epicardial flow disturbances and microvascular dysfunction. QRS complex fragmentation (fQRS) in surface ECG is caused by abnormal depolarization due to myocardial ischemia and scarring. It has been proved in different studies to be positively correlated with adverse cardiac events. This study aimed to assess the role of fQRS as a noninvasive predictor of CAE and its anatomical distribution. A total of 100 patients referred for elective coronary angiography were included and divided into 2 groups: 50 patients with isolated CAE (group A) and 50 patients with angiographically normal coronaries (group B, control group). Both groups were compared regarding clinical, echocardiographic, and ECG characteristics. Results: Univariate analysis showed a significant correlation between male sex, smoking, diabetes mellitus, increased systolic blood pressure, fQRS, echocardiographic evidence of diastolic dysfunction, and CAE (P values of 0.005, 0.002, 0.016, 0.027, 0.0001, and 0.04, respectively). Multivariate regression analysis showed that fQRS is the most important independent predictor for the presence of CAE (P < 0.00001) with sensitivity 94%, specificity 88%, PPV 88.7%, and NPV 93.6%. We also found a significant correlation between fQRS distribution in surface ECG and anatomical distribution of CAE [increased territories with multivessel affection (P = 0.00001), anterior leads with LAD affection (P = 0.00001), lateral and inferior leads with LCX affection (P = 0.003 and 0.04, respectively), inferior leads with RCA affection (P = 0.00001)]. Conclusion: fQRS in surface ECG can potentially be used as an effective non-invasive method to predict isolated CAE and its anatomical distribution. Publisher's NoteSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The comparison of serum TGF-beta levels and associated polymorphisms in patients with coronary artery ectasia and normal coronary artery

“…These are also well-known risk factors for the development of CAD. Moreover, Kamal et al also found in their study that male gender was frequent in patients with CAE and an independent risk factor for CAE development [ 27 ].…”

Evaluation of cardiac chamber functions by speckle‐tracking echocardiography in the presence of coronary artery flow disturbances other than stenosis: A review

“…Patients with CAE may more frequently suffer angina, myocardial infarction, and cardiovascular mortality 11,12 . CAE is also correlated with fragmented QRS and QTc dispersion 13,14 . Patients with CAT may suffer from angina, accompanied by ST‐segment changes in exercise tests 15 .…”

Left Ventricular Functions Assessment by Speckle Tracking in Comparison with The Two-Dimensional (2D) Echocardiography in Patients with Fragmented QRS

“…It has been reported that the presence of fQRS on a routine electrocardiogram (ECG) can give a reasonable indicator for the severity of cardiac involvement in different cardiac and/or systemic diseases (4) . Two-dimensional speckle tracking echocardiography (2D-STE) is a relatively new introduced method, which enable more reliable and complete myocardial function assessment by obtaining the myocardial strain and strain rates in the longitudinal, radial and circumferential directions based on the tracking of speckles in gray scale two-dimensional (2D) echocardiographic images (5) .…”