Association of Fragmented QRS Complex with Myocardial Reperfusion in Acute ST‐Elevated Myocardial Infarction

Abstract

In this study, we aimed to evaluate the relationship between TIMI myocardial perfusion (TMP) grade, as an indicator of myocardial reperfusion, and fragmented QRS (fQRS) in standard 12-lead electrocardiogram. Also, we evaluate fQRS is an additional indicator of myocardial reperfusion. One hundred patients admitted with first STEMI to Coronary Intensive Care Unit and who were used thrombolytic therapy was included in this retrospective study. Standard 12-lead electrocardiogram records of patients simultaneous with coronary angiography (second day) were assessed and analysed for the presence of fQRS. Also, coronary angiography images were analyzed to identify the infarct related artery, TIMI grade of infarct related artery and TMP grade of infarct related artery. The patients with fQRS demonstrated a significantly lower TMP grade, TIMI grade and ejection fraction compared with the non-fQRS patients (P = 0.004, P = 0.003, P = 0.02 respectively). The patients with inadequate myocardial reperfusion demonstrated a significantly higher fQRS compared with the adequate myocardial reperfusion patients. (56.9% versus 23.5%, P = 0.002 respectively). On correlation analysis, there was a significant negative correlation between fQRS and left ventricular ejection fraction (r = -232, P = 0.02) TMP grade and adequate myocardial reperfusion (TMP 3) showed significant negative correlation with fQRS (r = -0.370, P = 0.000; r = -0.318, P = 0.001 respectively). Presence of fragmented QRS in STEMI patients was associated with inadequate myocardial reperfusion and it can be used as a simple, noninvasive parameter to evaluate myocardial reperfusion.

The relationship between fragmentation on electrocardiography and in-hospital prognosis of patients with acute myocardial infarction

“…Similar findings have been determined in the study by Angue et al, in which the presence of fragmented QRS in patients with acute myocardial infarction was found to be associated with significant decrease in EF [18]. Also, the study by Erdem et al, performed on patients with acute ST elevation myocardial infarction, found a significant negative correlation between fragmented QRS and left ventricular ejection fraction, which supports our findings [19]. While the non-fragmented group’s mean EF was 49.93±10.48 (%), the mean EF in patients with ≥4 fragmentations was 38.54±11.84 (%).…”

Fragmented QRS (fQRS) Complex Predicts Adverse Cardiac Events of ST-Segment Elevation Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention and Thrombolysis

“…The degrees of myocardial ischemia and myocardial scars were correlated with the poor prognosis of patients [ 28 ]. However, previous studies [ 29 – 31 ] reported that the occurrence of myocardial coronary perfusion abnormality in fQRS patients is significantly enhanced, and the predictive value for the cardiac death is significantly higher compared to non-fQRS patients. A previous study [ 32 ] reported that the fQRS complex acts as a prognostic marker for microvascular reperfusion and LV dysfunction.…”

Diagnostic value of fragmented QRS complex in myocardial scar detection: systematic review and meta-analysis of the literature

“…And one study was excluded because the researchers assessed the correlation between fQRS and left ventricular aneurysm instead of myocardial scar [8]. Eight studies (2560 patients) were finally included in the systematic review [5,[9][10][11][12][13][14][15]. Table 1 shows the characteristics of the included studies.…”

“…Among the eight related studies the reported sensitivity varied in a wide range: 32% [11] to 86% [5]. Two studies reported a sensitivity below 50% for fQRS [11,14], and the sensitivity of fQRS in another six studies was higher than 60%. In the research by Wang et al [11] the patients' ECGs were performed within three months of the myocardial perfusion imaging (MPI) studies (not at the same time as the MPI).…”

“…Achieving a lower sensitivity for Q wave than the expected amount reported in the past literature is another sign that there is a potential error or restriction in ECG marker detection. Another study with discordance results was conducted in Turkey [14]. The authors aimed to evaluate the ability of fQRS as a marker of reperfusion.…”