Electrocardiographic changes associated with patchy myocardial fibrosis in the absence of confluent myocardial infarction

Weinberg, Sylvan Lee; Reynolds, Ralph W.; Rosenman, Ray H.; Katz, Louis N.

doi:10.1016/0002-8703(50)90203-1

Cited by 40 publications

(14 citation statements)

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“…Regional fQRS patterns denote the presence of a greater corresponding focal regional myocardial scar on stress myocardial perfusion imaging (30). Additionally, chronic ischemia may cause myocardial patchy fibrosis without prior MI (31). In previous studies were also found that fQRS is independently related to inadequate coronary collaterals in patients with chronic total occlusion (32,33).…”

Section: Discussionmentioning

confidence: 98%

Fragmented QRS may predict postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass graft surgery

Çetin¹,

Kocaman²,

Durakoğlugil³

et al. 2012

Anadolu Kardiyol Derg

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Fragmented QRS may predict postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass graft surgery Fragmente QRS izole koroner arter baypass greftleme operasyonu geçiren hastalarda postoperatif atriyal fibrilasyon gelişimini öngörebilir ABSTRACTObjective: Fragmented QRS complexes (fQRS) are defined as various RSR′ patterns in 2 contiguous leads corresponding to a major coronary artery territory. Although the reason of association between fQRS and cardiac events was documented as cardiac fibrosis, the predictive role of fQRS was not studied for postoperative atrial fibrillation (POAF) which is a frequent and serious complication in patients undergoing isolated coronary artery bypass graft (CABG) surgery. Therefore, this issue was investigated in the present study. Methods: The current study has a prospective observational design. Two hundred and seventy two eligible patients who underwent isolated CABG surgery were enrolled consecutively. The patients were divided in two groups with post-op atrial fibrillation (AF) and non-AF. The occurrence of new-onset AF following CABG and the relationship with fQRS were searched. The logistic regression analysis was used to determine independent predictors for POAF. The sensitivity and specificity of study variables in predicting POAF were calculated using a receiver-operating characteristic curve (ROC). Results: POAF occurred in 62 of 272 patients (22.8%). Patients with POAF were generally older (p<0.001) and female (p=0.006), with preexisting hypertension (p=0.008), lower hemoglobin levels (p=0.011), chronic obstructive lung disease (p=0.003), prolonged QRS time (p=0.004), and higher EUROSCORE (p<0.001) compared to non-AF patients. Patients with POAF had lower left ventricular ejection fraction (p<0.001) and high fQRS rate (p<0.001), but similar left atrial size (LA, p=NS). Interestingly, LA size was significantly enlarged in patients with fQRS (3.8±0.6 vs. 4.1±0.5 cm, p=0.002). In addition, the patients with POAF had prolonged stay in the cardiac surgery intensive-care unit (p<0.001) and extended in-hospital care (p=0.001). New-onset POAF was significantly related to the presence and number of fQRS. In the logistic regression analysis, only age (OR: 1.044, 95% CI: 1.008-1.082, p=0.016), female gender (OR: 2.347, 95% CI: 1.079-5.106, p=0.031), the presence and number of fQRS (OR: 6.020, 95% CI: 3.152-11.5 and OR: 1.522, 95% CI: 1.282-1.807, both of, p<0.001) were independent predictors of POAF. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and the diagnostic accuracy (DA) of presence of fQRS on pre-op electrocardiogram to predict POAF were 66%, 76%, 45%, 88% and 74%, respectively. The area under ROC was found as 0.733 (p<0.001, 95% CI: 0.657-0.810). Conclusion: In our study, we found that new-onset POAF was independently related to the presence and number of fQRS in patients undergoing CABG surgery. In addition, fQRS on pre-op surface ECG had high predictive values for new-onset POAF. (Anadolu Kard...

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Section: Discussionmentioning

confidence: 98%

Fragmented QRS may predict postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass graft surgery

Çetin¹,

Kocaman²,

Durakoğlugil³

et al. 2012

Anadolu Kardiyol Derg

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“…9 " 11 We found notching more common in angina pectoris a disease in which Zoll, Wessler, and Blumgart frequently found multiple infarctions. 10 These cause interspersed patches of living and dead myocardium. However, patchy necrosis or fibrosis due to coronary disease is not the only cause of notching and other similar deformities in the electrocardiograms.…”

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confidence: 99%

Characteristics of the Frequency Spectrum in the Normal Electrocardiogram and in Subjects Following Myocardial Infarction

Langner

Geselowitz

1960

Circulation Research

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The results of a study of the sealar electrocardiogram, utilizing a wide-band recorder, expanded time scale and a low-pass filter, indicate that a recorder flat to at least 500 c.p.s. is required for faithful reproduction. With a high-pass filter, measurable residual signals are present at a cut-off frequency of 1,000 c.p.s., or higher. Therefore, to record these, an adequate response at 1,000 c.p.s. or more is reqnired. The high frequency energy of the electrocardiographic spectrum arises from the fast deflections contained in the original waveform. These may occur in a single fast deflection, notching, or both. Whereas, in the normal individual, high frequency energy usually arises from a relatively smooth, fast deflection, in abnormals the fast events may occur in conjunction with notching, and other deformities. Judging from the technic used in this experiment, a variable band-pass filter is valuable as an aid for studying the high frequency components of the electrocardiogram and establishing equipment requirements. Measurement of peak-to-peak voltage of residual signals gives partial but lot clear-cut separation of normal and abnormal subjects and would not seem to add to the value of high-fidelity electrocardiography per se in routine clinical diagnosis. It is possible that root mean square readings, reflecting the total energy content, might give a better separation between normal and abnormal subjects than peak-to-peak amplitude alone.

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“…ECG abnormalities are the result of changes in the electrical property of the myocardium, usually associated with histological abnormalities, and homogeneity of the normal myocardium disappears in heart failure secondary to either ischaemia or other aetiologies [23]. The shift of horizontal QRS axis from left lateral to left posterior indicates a relatively increased electrical force in the posterior aspect of the heart, which could be due to myocardial loss in the interventricular septum secondary to infarction, or to asymmetrical hypertrophy of the left ventricular posterior wall or to QRS broadening.…”

Section: Discussionmentioning

confidence: 99%

The prognostic significance of horizontal plane QRS axis in elderly heart failure

Xiao¹,

McCan²,

Kaufman³

2006

International Journal of Cardiology

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Electrocardiographic changes associated with patchy myocardial fibrosis in the absence of confluent myocardial infarction

Cited by 40 publications

References 15 publications

Fragmented QRS may predict postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass graft surgery

Fragmented QRS may predict postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass graft surgery

Characteristics of the Frequency Spectrum in the Normal Electrocardiogram and in Subjects Following Myocardial Infarction

The prognostic significance of horizontal plane QRS axis in elderly heart failure

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