Myocardial Tissue Perfusion Predicts the Evolution of Fragmented QRS in Patients with ST‐Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Abstract

Our findings showed that despite complete ST-segment resolution in all patients, fQRS is independently associated with impaired microvascular myocardial perfusion. So, fQRS, as a simple and easily available noninvasive marker, may be useful in stratification of high-risk patients with increased extent of infarcted myocardium who underwent primary PCI.

Prognostic significance of fragmented QRS in patients with ST-elevation myocardial infarction undergoing revascularization

“…Imperfect ST-segment resolution after PCI was independently associated with cardiac dysfunction, cardiac death, and short- and long-term clinical prognosis in patients with STEMI 21 . Recent studies have negatively correlated fQRS with reperfusion parameters such as ΣSTR12, 13 and myocardial blush grade 11 in patients with STEMI. Similarly, we have found that new onset or persistent fQRS was significantly associated with impaired myocardial reperfusion as estimated by ΣSTR after PCI in our cohort.…”

“…In patients with STEMI, prolonged QRS time was associated with increased long-term mortality due to increased incidence of heart failure, arrhythmia, and ischemia 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19. In our study, fQRS was related to prolonged QRS duration after PCI (p < 0.001) with lesser delta QRS time ( p = 0.01).…”

“…Recent studies have shown that fQRS may be of significant prognostic value in patients with STEMI undergoing reperfusion therapy 6, 7, 8, 9, 10. STEMI patients with fQRS in electrocardiogram (ECG) tend to have higher cardiac biomarker levels, higher inflammatory markers, higher angina to balloon time, lower left ventricular function, extensive coronary artery involvement, and poorer reperfusion parameters 11, 12, 13. fQRS predicts short-term and long-term mortality and major cardiac events and thus is helpful in risk stratification in patients with STEMI.…”

Temporal Trend Might Be Better Than Instant Occurrence of fQRS as a Noninvasive Prognostic Marker in STEMI Patients Undergoing Primary PCI

“…[2][3][4][5] In a recent study, Lorgis et al 5 showed that the presence of fQRS was associated with a significantly lower left ventricular ejection fraction, increased left ventricular volumes, a larger infarct size, and a larger peri-infarct zone in patients who underwent cardiac magnetic resonance imaging during the week after acute myocardial infarction. [2][3][4][5] In a recent study, Lorgis et al 5 showed that the presence of fQRS was associated with a significantly lower left ventricular ejection fraction, increased left ventricular volumes, a larger infarct size, and a larger peri-infarct zone in patients who underwent cardiac magnetic resonance imaging during the week after acute myocardial infarction.…”

Fragmented QRS complex is a prognostic marker of microvascular reperfusion and changes in LV function occur in patients with ST elevation myocardial infarction who underwent primary percutaneous coronary intervention

“…The presence of a fragmented QRS (fQRS) complex including narrow or wide QRS complex, which corresponds to the depolarization of the right and left ventricles of the human heart is frequently recorded following surface electrocardiograms (ECGs). Previous studies have identified that fQRS complex on surface ECG is a predictor of adverse cardiovascular events, including cardiac mortality and heart failure ( 3 , 4 ). In clinical terms, the presence of fQRS is common among patients with biventricular enlargement and myocardial infarction (MI) ( 5 ).…”