Baseline fragmented QRS is associated with increased all‐cause mortality in heart failure with reduced ejection fraction: A systematic review and meta‐analysis

Kanitsoraphan, Chanavuth; Rattanawong, Pattara; Mekraksakit, Poemlarp; Chongsathidkiet, Pakawat; Riangwiwat, Tanawan; Kanjanahattakij, Napatt; Vutthikraivit, Wasawat; Klomjit, Saranapoom; Thavaraputta, Subhanudh

doi:10.1111/anec.12597

Cited by 15 publications

(25 citation statements)

References 26 publications

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“…Gulsen et al showed that fragmented QRS could predict mortality in aortic stenosis patients after transcatheter aortic valve replacement (TAVR) procedure (Gulsen et al, 2019). Kanitsoraphan et al showed that baseline fQRS is associated with increased all-cause mortality in patients with HF reduced LVEF (Kanitsoraphan et al, 2019). Attachaipanich et al showed that the presence of fQRS complex on admission ECG was found to be an independent predictor of in-hospital lifethreatening arrhythmic events in ST-segment elevation myocardial infarction (STEMI) patients (Attachaipanich & Krittayaphong, 2019).…”

Section: Discussionmentioning

confidence: 99%

The relationship between galectin‐3 levels and fragmented QRS (fQRS) in patients with heart failure with reduced left ventricular ejection fraction

Barman

Durmaz

Atıcı

et al. 2019

Noninvasive Electrocardiol

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Heart failure (HF) is a highly prevalent disease in the general population which requires repeat hospitalization and causes significant morbidity and mortality (Ponikowski et al., 2016;Yancy, Jessup, & Bozkurt, 2017). As a consequence of this serious outcomes, HF results in a high economic burden for healthcare systems. Therefore, early recognition of poor outcome predictors is essential for patient management.Mortality occurs commonly due to pump failure or arrhythmogenic episodes (Goldstein & Hjalmarson, 1999;Narang, Clelandf, & Erhardt, 1996). Whether ischemic or nonischemic origin, patients with HF have more myocardial fibrosis than healthy subjects which is a substrate for arrhythmias and negative remodeling which gradually decreases left ventricular functions (Bernardo, Weeks,

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Section: Discussionmentioning

confidence: 99%

The relationship between galectin‐3 levels and fragmented QRS (fQRS) in patients with heart failure with reduced left ventricular ejection fraction

Barman

Durmaz

Atıcı

et al. 2019

Noninvasive Electrocardiol

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“…They concluded that fQRS could be a valuable predictor of clinical outcome in patients with HFrEF. [27] In our study, we have found that there were more patients diagnosed as NSTEMI among patients with fQRS than among patients without. In a recently published study by (Puelacher et al, [28], assessed the relative incidence and compared the characteristics and outcome of unstable angina (UA) and NSTEMI.…”

Section: Discussionmentioning

confidence: 46%

“…They have concluded that fQRS was found to be an independent predictor of in-hospital life-threatening arrhythmic events in these patients. In recently published meta-analysis by (Kanitsoraphan et al, [27], they studied the effect of fQRS on all-cause mortality in patients with heart failure and reduced ejection fraction (HFrEF). In their meta-analysis, Kanitsoraphan and his colleagues found that fQRS in baseline electrocardiogram was associated with increased allcause mortality up to 1.63-fold in this group of patients.…”

Section: Discussionmentioning

confidence: 99%

Fragmented QRS Complex as a Predictor of High Risk in Acute Coronary Syndrome

Radwan¹,

Mansour²,

Al-Daydamony³

et al. 2019

CCR

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Background: To detect the potential in hospital prognostic value of fQRS complex in patients with acute coronary syndrome (ACS) & investigate whether FQRS complex can be used to distinguish patients with early NSTEMI from those with unstable angina. Methods: It included 150 patients with acute NSTEMI and unstable angina. All patients were subjected to Grace score calculation, ECG to detect ischemic changes and detect presence or absent of fQRS, transthoracic echo to detect LV ejection fraction and recording in-hospital outcome. Results: Patients with fQRS have significant higher Killip class>2, higher troponin &CKMB levels, higher grace score, increased LVEDD & LVESD and significantly lower LVEF%. LVEF is significantly lower among patients with fQRS than patients with not fQRS in NSTEMI patients while there is no significant difference of LVEF % between both groups in unstable angina patients. There is significant association between fQRS and higher prevalence of NSTEMI and higher incidence of heart failure, arrhythmia and bad outcome. By multivariate analysis, NSTEMI (p =0.003) and high HR (p =0.004) and fragmented QRS (p =0.00) were the only significant predictors for bad outcome. FQRS have the ability to diagnose NSTEMI in 47.9% of cases, fQRs can truly exclude NSTEMI in 72.7% of case. Conclusion: Among patients with ACS, the presence of fQRS was associated with an increase incidence of complication, worse outcome, larger LV dimensions, and lower LVEF. The presence of fQRS in acute coronary syndrome patients could predict the presence of NSTEMI with fair diagnostic value.

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“…Additionally, myocardial scars detected using fQRS are a substrate for re-entrant ventricular tachyarrhythmia [37]. A metaanalysis of patients with reduced EF showed that fQRS was associated with increased all-cause mortality up to 1.63-fold, as well as increased major arrhythmic events up to 1.74-fold [38]. Another meta-analysis of patients with acute coronary syndrome reported that fQRS was an independent predictor of mortality, major adverse cardiovascular events, and deteriorating LV function [15].…”

Section: Discussionmentioning

confidence: 99%

Fragmented QRS complex in patients with systemic lupus erythematosus at the time of diagnosis and its relationship with disease activity

et al. 2020

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Objective Cardiovascular disease is an important contributor to the mortality rate of patients with systemic lupus erythematosus (SLE), which is related to SLE disease activity. Fragmented QRS (fQRS) complexes, defined by additional spikes in the QRS complex, are useful for identifying myocardial scars on electrocardiography and can be an independent predictor of cardiac events. We aimed to assess the relationship between disease activity in patients with SLE and fQRS at the time of diagnosis. Methods Forty-four patients with SLE were included. Patients with cardiac diseases, other rheumatic diseases, and prior treatment at the time of electrocardiography measurement were excluded. The appearance of fQRS represented exposure. The primary outcome was SLE Disease Activity Index 2000 (SLEDAI-2K). Multiple regression analysis was conducted to assess the association between fQRS and SLEDAI-2K adjusted for age, sex, and time from the estimated onset date to the date of diagnosis. Results Among patients with SLE at diagnosis, 26 (59.1%) had fQRS. The median SLEDAI-2K was 18 (interquartile range [IQR], 12-22) and 9 (IQR, 8-15) in the fQRS(+) and fQRS(-) groups, respectively. SLEDAI-2K was significantly higher in the fQRS(+) group than in the fQRS(-) group (regression coefficient, 2.69; 95% confidence interval, 0.76-4.61; p = 0.008).

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Baseline fragmented QRS is associated with increased all‐cause mortality in heart failure with reduced ejection fraction: A systematic review and meta‐analysis

Cited by 15 publications

References 26 publications

The relationship between galectin‐3 levels and fragmented QRS (fQRS) in patients with heart failure with reduced left ventricular ejection fraction

The relationship between galectin‐3 levels and fragmented QRS (fQRS) in patients with heart failure with reduced left ventricular ejection fraction

Fragmented QRS Complex as a Predictor of High Risk in Acute Coronary Syndrome

Fragmented QRS complex in patients with systemic lupus erythematosus at the time of diagnosis and its relationship with disease activity

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