Frontal QRS-T angle is independent predictor of non-dipper status in hypertensive patients without LVH.

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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

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...

The presence of fQRS in the anterior leads may indicate more severe CAD compared to fQRS in the inferior leads in patients undergoing a first diagnostic coronary angiography.

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BackgroundFragmented QRS (fQRS) is a sign of adverse cardiovascular events in various cardiovascular diseases. It is also associated with increased blood pressure and non-dipping in hypertensive patients. However, no study has investigated the importance of fQRS in prehypertensive patients.ObjectivesThe aim of our study is to investigate the relationship between fQRS and non-dipper status in prehypertensive patients.MethodsTwo hundred and sixteen eligible, newly diagnosed prehypertensive patients who underwent 24-hour ambulatory blood pressure monitoring (ABPM) for further evaluation of blood pressure between June 2015 and July 2016 were included into the study. Patients were divided into three groups according to ABPM results: normotensives, dipper prehypertensives, and non-dipper prehypertensives. Groups were compared regarding presence of fQRS on electrocardiography. Additionally, multinomial logistic regression analysis was used to determine the relationship between fQRS and blood pressure pattern in prehypertensive patients.ResultsAccording to ABPM recordings, 61 patients had normotensive blood pressure pattern (systolic blood pressure < 120 mmHg and diastolic blood pressure < 80 mmHg). Of the remaining 155 prehypertensive patients, 83 were dippers and 72 were non-dippers. Non-dipper prehypertensives had a significantly higher frequency of fQRS compared to normotensives (p = 0.048). Furthermore, multinomial logistic regression analysis revealed that fQRS is an independent predictor of non-dipping blood pressure pattern in prehypertensive patients (p = 0.017, OR: 4.071, 95% CI: 1.281-12.936).ConclusionsWe found that fQRS is a predictor of non-dipping in prehypertensives. As a marker of fibrosis and higher fibrotic burden within myocardium, fQRS may be useful in identifying high-risk prehypertensive patients before the development of hypertension.