Fragmented QRS and Mortality Risk in Patients With Left Ventricular Dysfunction

Cheema, Aamir; Khalid, Adnan; Wimmer, Alan P.; Bartone, Cheryl; Chow, Theodore; Spertus, John A.; Chan, Paul S.

doi:10.1161/circep.110.940478

Cited by 76 publications

(79 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These fragmentations on surface ECG were associated with increased adverse cardiovascular events (CVEs) in previous studies (2)(3)(4)(5). The reason of documented association between fragmented QRS (fQRS) and increased morbidity and mortality, sudden cardiac death and recurrent CVEs were investigated by several studies (4)(5)(6)(7)(8)(9)(10). In these studies, the main causative mechanism of fQRS was cardiac fibrosis (11,12).…”

Section: Introductionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

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...

show abstract

Section: Introductionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

show abstract

“…That is why f-QRS presence in patients after MI might be a marker of severe left ventricular dysfunction [15]. However, in a larger population, with LVEF ≤ 35%, who received implantable cardioverter defibrillator (ICD) for sudden cardiac death primary prevention, f-QRS was not associated with a higher risk of arrhythmic mortality [16]. According to current guidelines, impaired left ventricular systolic function and ventricular arrhythmias are one of the indications for ICD implantation [17].…”

Section: Resultsmentioning

confidence: 99%

Fragmentation of the QRS complex in patients with acute coronary syndrome treated invasively

et al. 2016

View full text Add to dashboard Cite

A b s t r a c tBackground: Previous studies showed that the presence of fragmented QRS (f-QRS) in patients with acute coronary syndrome (ACS), who underwent complete revascularisation, is associated with worse prognosis and the possibility of arrhythmia occurrence. Aim:To assess the prognostic value of f-QRS in patients with ACS and complete revascularisation, in the context of cardiac arrhythmias. Methods:We analysed 124 consecutive patients (66.1% males; mean age 62.38 ± 11.0 years) with ACS (STEMI 49%) treated invasively. Based on electrocardiogram (ECG) record, performed during the admission to the clinic, after the complete revascularisation (TIMI = 3) and during discharging from hospital (4 th -5 th days after ACS), we classified QRS as f-QRS based on generally accepted criteria (QRS < 120 ms, which included an additional R wave [R']) or notching in the nadir of the S wave, or > 1 R' (fragmentation) in two contiguous leads, corresponding to a major coronary artery territory. 24-h Holter ECG recording was performed on the fifth day after ACS to assess the frequency of conduction disturbances and others arrhythmias.Results: There were no statistically significant differences between patients with and without f-QRS during hospitalisation. In the patients with f-QRS there were no statistically significant conduction disturbances and other arrhythmias compared to patients without f-QRS at discharge. Conclusions:In the patients with ACS, who underwent successful revascularisation (TIMI = 3), the presence of f-QRS is not correlated with a higher incidence of arrhythmias compared to patients without f-QRS in short-term follow-up.

show abstract

“…Heart failure is commonly seen in patients with a large area of myocardial infarction (>40%) and sometimes results in cardiogenic shock. FQRS has been proved to be valuable tool for predicting the incidence of malignant cardiac arrhythmia and left ventricular systolic dysfunction (4).The presence of fQRS on ECG is associated with myocardial scarring, ischemia, and fibrosis and originates from deterioration in the process of signal transduction and ventricular depolarization (5). The presence of fQRS in coronary artery disease (CAD) patients is known to be significantly associated with MACE, left ventricular dysfunction, and impairment of myocardial perfusion (6,7).…”

Section: Issn: 2320-5407mentioning

confidence: 99%

Impact of QRS Complex Fragmentation on Hospital Outcome of Patients Undergoing Primary Percutaneous Coronary Intervention.

Badawi¹,

Mahfouz²,

Moustafa³

et al. 2017

IJAR

View full text Add to dashboard Cite

Fragmented QRS and Mortality Risk in Patients With Left Ventricular Dysfunction

Cited by 76 publications

References 21 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

Fragmentation of the QRS complex in patients with acute coronary syndrome treated invasively

Impact of QRS Complex Fragmentation on Hospital Outcome of Patients Undergoing Primary Percutaneous Coronary Intervention.

Contact Info

Product

Resources

About