Significance of Fragmented QRS Complexes for Identifying Left Ventricular Hypertrophy in Patients with Hypertension

Zhang, Baowei; Zhen, Yan; Shen, Dongli; Zhang, Guohui

doi:10.1111/anec.12212

Cited by 23 publications

(18 citation statements)

References 21 publications

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“…1 They used the left ventricular ejection fraction, septum and posterior wall thickness, gradients, strain pattern, and systolic pulmonary artery pressure as echocardiographic parameters. 3 In the present study of Açıkgöz, et al there are significantly higher mean and peak gradients in patients with fQRS group. In a study which includes patients with hypertension and normal coronary angiogram, LVMI was significantly higher in the patients with fQRS than that of patients who did not have fQRS on ECG.…”

supporting

confidence: 44%

Presence of Fragmented QRS May Be Due to Higher Levels of Left Ventricle Mass in Patients with Severe Aortic Stenosis

Eyuboglu

2015

Noninvasive Electrocardiol

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supporting

confidence: 44%

Presence of Fragmented QRS May Be Due to Higher Levels of Left Ventricle Mass in Patients with Severe Aortic Stenosis

Eyuboglu

2015

Noninvasive Electrocardiol

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“…However, its importance in patients with hypertension is not well described, particularly in patients without LVH. It has been shown that the frequency of fQRS is significantly higher in patients with LVH compared with absence of LVH in individuals with hypertension . This finding may indicate the higher fibrotic burden in patients with LVH.…”

Section: Discussionmentioning

confidence: 96%

“…This finding also indicates the importance of higher fibrotic burden in myocardium and electrocardiographic risk assessment of persons with hypertension in the absence of LVH. The higher frequency of fQRS in the hypertensive population seems to be mainly related to LVH, and CAD‐related fibrosis is one of the most powerful predictors of presence of fQRS on ECG . Hence, we excluded all patients with LVH to avoid its effect on fQRS frequency.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of fragmented QRS in hypertensive patients in the absence of left ventricular hypertrophy

Eyuboglu¹,

Karabağ

Karakoyun

et al. 2017

J of Clinical Hypertension

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In the absence of left ventricular hypertrophy, importance of fragmented QRS complex (fQRS) in individuals with hypertension is unknown. The authors aimed to evaluate the relationship between blood pressure levels and fQRS in the absence of left ventricular hypertrophy. A total of 548 never-treated patients who underwent 24-hour ambulatory blood pressure monitoring were enrolled. The frequency of fQRS was significantly higher in patients with hypertension than normotension (36.4% vs 17.6%, P<.05). Multivariate logistic regression analysis revealed that systolic blood pressure is significantly associated with presence of fQRS on electrocardiography fQRS may be a sign of increased blood pressure and may predict higher fibrotic burden in patients with hypertension. | INTRODUCTIONThere is a strong correlation between increased blood pressure (BP) levels and cardiovascular events. 1 Despite the estimated prevalence of hypertension of ≈30% to 45% of the general population, the presence of difficulties in the diagnosis and treatment causes an inability to control and monitor the condition. 2 Electrocardiography (ECG) plays an important role in the monitoring of patients with hypertension; however, ECG abnormalities seem to mainly be the sign of left ventricular hypertrophy (LVH) and increased left ventricular mass caused by chronic pressure overload. 3 BP elevation is an important cause of fibrotic burden in myocardium, and chronic pressure overload related to collagen synthesis is the main reason for fibrosis in individuals with hypertension. 4 However, progression from early-stage fibrosis to manifest LVH as end organ damage is likely a lengthy process. A narrow fragmented QRS complex (fQRS) as a ventricular conduction abnormality is a sign of myocardial fibrosis and is associated with adverse outcomes in various cardiovascular diseases. 5-7 Therefore, presence of fQRS on ECG, as an indicator of myocardial fibrosis, may be a sign of increased BP even in the absence of manifest LVH. In the present study, we aimed to investigate whether increased BP levels have a positive correlation with the presence of fQRS on ECG in the absence of LVH and to demonstrate the usefulness of fQRS before the development of LVH. | METHODS | Study participantsIn all, 614 consecutive patients who were never treated and referred to our outpatient clinic for suspicion of hypertension and underwent 24-hour ambulatory BP monitoring (ABPM) between July 2015 and July 2016 were enrolled. Patients with LVH (n=24), previous myocardial infarction and/or coronary artery bypass graft surgery (n=13), complete or incomplete bundle branch block and QRS duration ≥120 ms (n=11), left ventricular ejection fraction <50% (n=10), and moderate to severe valvular heart disease (n=8) were excluded. As a result, the remaining 548 patients were included in the study. All individuals were evaluated with a detailed anamnesis, physical examination, laboratory analysis, echocardiography, and ECG. LVH was defined according to electrocardiographic modified Sokolow-Lyon in...

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“…18 Additionally, in the absence of CAD, left ventricular hypertrophy and increased left ventricle mass are associated with higher frequency of fQRS in patients with normal left ventricular ejection fraction. 19-21 Therefore, in our study, in addition to vascular diseases, we excluded patients with lower ejection fraction, moderate to severe valvular diseases and evidence of left ventricular hypertrophy to identify the exact predictive value of fQRS in terms of presence of CAD and CAD severity.…”

Section: Discussionmentioning

confidence: 99%

Fragmented QRS for Risk Stratification in Patients Undergoing First Diagnostic Coronary Angiography

Eyuboglu¹,

Ekinci²,

Karakoyun³

et al. 2016

Arquivos Brasileiros De Cardiologia

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BackgroundOnly a small proportion of patients referred for coronary angiography with suspected coronary artery disease (CAD) have the diagnosis of obstructive CAD confirmed by the exam. For this reason, further strategies for risk stratification are necessary.ObjectiveTo investigate the relationship of the presence of fragmented QRS (fQRS) on admission electrocardiogram with angiographically detected CAD and CAD severity in patients without known vascular diseases and myocardial fibrosis, undergoing first diagnostic coronary angiography.MethodsWe enrolled 336 consecutive patients undergoing coronary angiography for suspected CAD. The patients were divided into two groups according to the presence or absence of fQRS on admission. We compared the groups regarding the presence and severity of CAD.ResultsSeventy-nine (23.5%) patients had fQRS on admission. There was not a statistically significant difference between patients with fQRS (41.8%) and non-fQRS (30.4%), regarding the presence of CAD (p = 0.059). However, there was a statistically significant difference between patients with fQRS and non-fQRS regarding the presence of stenotic CAD (40.5% vs. 10.5%, p<0.001) and multi vessel disease (25,3% vs. 5.1%, p<0.001). The frequency of fQRS was significantly higher in patients with SYNTAX score >22 compared to patients with SYNTAX score ≤22.ConclusionsOur findings suggest that fQRS may be an indicator of early-stage myocardial damage preceding the appearance of fibrosis and scar, and may be used for risk stratification in patients undergoing first diagnostic coronary angiography

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Significance of Fragmented QRS Complexes for Identifying Left Ventricular Hypertrophy in Patients with Hypertension

Abstract: fQRS is a common electrocardiographic phenomenon in patients with hypertension. Although the diagnostic value for LVH is limited, the presence of fQRS on ECG is associated with a higher risk for worse LVH.

Cited by 23 publications

References 21 publications

Presence of Fragmented QRS May Be Due to Higher Levels of Left Ventricle Mass in Patients with Severe Aortic Stenosis

Presence of Fragmented QRS May Be Due to Higher Levels of Left Ventricle Mass in Patients with Severe Aortic Stenosis

Usefulness of fragmented QRS in hypertensive patients in the absence of left ventricular hypertrophy

Fragmented QRS for Risk Stratification in Patients Undergoing First Diagnostic Coronary Angiography

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