Total Mortality, Major Adverse Cardiac Events, and Echocardiographic‐Derived Cardiac Parameters with Fragmented QRS Complex

Gong, Bojun; Li, Zicheng

doi:10.1111/anec.12325

Cited by 16 publications

(14 citation statements)

References 28 publications

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“…This finding is concordant with previous reports which found lower LVEF, and larger left ventricular systolic and diastolic dimensions and volumes in patients with fQRS and CAD. 21,25 As we included only AMI patients, we can assume that appearance of QRS fragmentation even in the early phase of AMI may indicate larger infarct size and worse LV systolic function. This correlation may partially explain the worse prognosis in patients with fQRS (+).…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10][11][12][13][14][15][16][17][18] Some recent papers reviewed the clinical importance of fQRS in patients with cardiovascular diseases. [19][20][21] However, the literature regarding the definition and the prognostic value of fQRS in patients with AMI is heterogeneous and the findings are not easy to interpret. Thus, in this meta-analysis we recruited studies of STEMI and NSTEMI and investigated the association of fQRS with short-/long-term mortality and major adverse cardiovascular events (MACE) in patients with AMI.…”

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confidence: 99%

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Prognostic Value of QRS Fragmentation in Patients with Acute Myocardial Infarction: A Meta‐Analysis

Güngör

Özcan²,

Karataş

et al. 2016

Noninvasive Electrocardiol

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We searched PubMed, Embase, Web of Science, and Cochrane Library up to October 2015 for eligible studies. We selected studies with fQRS defined with 12-lead ECG during the index hospitalization of STEMI/NSTEMI. Primary outcomes were in-hospital and long-term cardiovascular events. In-hospital mortality was significantly higher in fQRS (+) group (99/733; 13.5%) compared to fQRS (-) group (47/1293; 3.6%) (OR 4.03 95% CI 1.81-8.94; P = 0.0006). Long-term mortality rate was higher in fQRS (+) group (89/473; 18.8%) compared to fQRS (-) group (54/1009; 5.3%) (OR 3.93 95% CI 1.92-8.05; P = 0.0002). In addition the frequency of long-term MACE was higher in fQRS (+) group (46.9%) compared to fQRS (-) group (14.6%) (OR 5.13 95% CI 2.77-9.51; P < 0.00001) CONCLUSION: Presence of fQRS on admission ECG was found to be predictor of mortality, MACE, deterioration of LV function, and presence of multivessel disease in patients with STEMI and NSTEMI.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Prognostic Value of QRS Fragmentation in Patients with Acute Myocardial Infarction: A Meta‐Analysis

Güngör

Özcan²,

Karataş

et al. 2016

Noninvasive Electrocardiol

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“…Fragmented QRS complex (fQRS), which was defined by the presence of changes in QRS morphology including an additional R wave, a notching of the R wave or S wave, or the presence of >1 additional R wave in 2 contiguous leads is a novel electrocardiographic parameter to define high risk patients in various circumstances [17]. It has been related to a number of cardiac diseases including Brugada syndrome, ventricular aneurysm, dilated cardiomyopathy, essential hypertension, coronary artery disease, tetralogy of Fallot, takotsubo cardiomyopathy, cardiac AL amyloidosis, heart failure and acute aortic dissection [18][19][20][21].…”

Section: Discussionmentioning

confidence: 99%

Akut miyokarditte fragmante QRS kompleksinin prognostik rolü

Ünal

Yılmaz

Yayla

et al. 2019

Turkish Journal of Clinics and Laboratory

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Aim: Although a fulminant course of the myocarditis is difficult to predict, it may lead to acute heart failure and death. Previous studies have demonstrated that reduced left ventricular systolic function and prolonged QRS duration can predict the fulminant course. This study aimed to identify whether fragmented QRS complex (fQRS) could also be predictive of fulminant disease in this population. Material and Methods: We retrospectively included 156 patients diagnosed with acute myocarditis. They were divided into the fulminant group (n = 18) and the non-fulminant group (n = 138). Multivariate logistic regression analysis was used to identify the independent factors predictive of fulminant disease. Results: Fragmented QRS developed in 11 (61%) in the fulminant group and only 10 patients (7%) in the non-fulminant group (p <0.001). Patients with fulminant myocarditis had a higher mortality rate than those with non-fulminant disease (44.6% vs. 0%, p < 0.001). Multivariate analysis revealed that the presence of fQRS (p=0.019), longer Tpe/qt ratio (p=0.022) and clinical heart failure (<0.001) were significant predictors associated with a fulminant course of myocarditis. Conclusion: The presence of fQRS complex, as a simple and feasible electrocardiographic marker, seems to be a novel predictor fulminant myocarditis. This simpleparameter may be used in identifying patients at high risk for fulminancy and so early mechanical support could provide improved patient outcomes.

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“…Especially when occurring in the lateral territory fQRS has been noticed to increase not only the non-fatal cardiac events and long-term cardiovascular events but also mortality in patients with CAD (Jain et al, 2014; Gong and Li, 2016; Güngör et al, 2016). It is possible that fQRS could detect some subclinical regional left ventricle dysfunction in patients with CAD (Yan et al, 2012).…”

Section: Backgroundsmentioning

confidence: 99%

“…fQRS can also be associated with low LVEF. (Fares et al, 2013; Lorgis et al, 2014; Gong and Li, 2016; Güngör et al, 2016; Ma et al, 2016) and multi-vessel CAD in patients with STEMI (Ma et al, 2016) and NSTEMI (Güngör et al, 2016) which may explain the association with adverse prognosis. In silent MIs, which are problematic to discover in diabetics, women with unusual chest pain and in senile dementia, fQRS can be the only evidence of the ongoing event (Fares et al, 2013).…”

Section: Backgroundsmentioning

confidence: 99%

QRS Fragmentation Patterns Representing Myocardial Scar Need to Be Separated from Benign Normal Variants: Hypotheses and Proposal for Morphology based Classification

et al. 2016

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The presence of a fragmented QRS complex (fQRS) in two contiguous leads of a standard 12-lead electrocardiogram (ECG) has been shown to be an indicator of myocardial scar in multiple different populations of cardiac patients. QRS fragmentation is also a predictor of adverse prognosis in acute myocardial infarction, coronary artery disease, and ischemic cardiomyopathy and a prognostic tool in structural heart diseases. An increased risk of sudden cardiac death associated with fQRS has been documented in patients with ischemic cardiomyopathy and hypertrophic cardiomyopathy. However, fQRS is also frequently observed in apparently healthy subjects. Thus, a more detailed classification of different QRS fragmentations is needed to identify the pathological fragmentation patterns and refine the role of fQRS as a risk marker of adverse cardiac events and sudden cardiac death. In most studies fQRS has been defined by the presence of an additional R wave (R′), or notching in the nadir of the S wave, or the presence of >1 R′ in two contiguous leads corresponding to a major coronary territory. However, this approach does not discriminate between minor and major fragmentations and the location of the fQRS is also neglected. In addition to this, the method is susceptible to large interobserver variability. We suppose that some fQRS subtypes result from conduction delays in the His-Purkinje system, which is a benign finding and thus can weaken the prognostic values of fQRS. The classification of fQRSs to subtypes with unambiguous definitions is needed to overcome the interobserver variability related issues and to separate fQRSs caused by myocardial scarring from benign normal variants. In this paper, we review the anatomic correlates of fQRS and the current knowledge of prognostic significance of fQRS. We also propose a detailed fQRS classification for research purposes which can later be simplified after the truly pathological morphologies have been identified. The research material of our study consist of 15,245 ECGs from the random general population and approximately six thousands (n = 6,241) ECGs from subjects with a known cardiac disease.

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Total Mortality, Major Adverse Cardiac Events, and Echocardiographic‐Derived Cardiac Parameters with Fragmented QRS Complex

Abstract: Our findings indicate that fQRS is a valuable factor to predict total mortality and MACE in patients with CAD.

Cited by 16 publications

References 28 publications

Prognostic Value of QRS Fragmentation in Patients with Acute Myocardial Infarction: A Meta‐Analysis

Prognostic Value of QRS Fragmentation in Patients with Acute Myocardial Infarction: A Meta‐Analysis

Akut miyokarditte fragmante QRS kompleksinin prognostik rolü

QRS Fragmentation Patterns Representing Myocardial Scar Need to Be Separated from Benign Normal Variants: Hypotheses and Proposal for Morphology based Classification

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