Presence of fragmented QRS is associated with increased epicardial adipose tissue thickness in hypertensive patients

Abstract

Background Epicardial adipose tissue (EAT) is a cardiometabolic risk factor, and its possible relationship with hypertension has been reported previously. Fragmented QRS (fQRS) detected on electrocardiography (ECG) has been demonstrated to be a marker of myocardial fibrosis. In this study, we aimed to investigate the relationship between the thickness of EAT, and presence of fQRS in hypertensive patients. Methods Consecutive patients who were diagnosed with hypertension were included in the study. ECG and transthoracic echocardiography (TTE) were performed to all patients. fQRS was defined as additional R′ wave or notching/splitting of S wave in two contiguous ECG leads. Thickness of EAT was measured by TTE. Results This study enrolled 69 hypertensive patients with fQRS on ECG and 45 hypertensive patients without fQRS as the control group. Age (P = .869), and gender distribution (P = .751) were similar in both groups. Left atrial diameter (P = .012), interventricular septal thickness (P < .001), posterior wall thickness (P < .001), left ventricular ejection fraction (P = .009), left ventricular mass (P = .006), left ventricular mass ındex (P = .014), left ventricular hypertrophy (P = .003), and EAT thickness (P < .001) were found to be significantly increased in patients with fQRS. In multivariate analysis, among these variables only EAT was observed to be an independent predictor of fQRS (odds ratio:3.306 [95% confidence interval, 0.030‐0.118], P = .001). Conclusion A significant association exists between the presence of fQRS and EAT thickness in hypertensive patients. The presence of fQRS, just as EAT thickness, may be used as a cardiometabolic risk factor in hypertensive patients.

Fragmented QRS in inferior leads is associated with non-alcholic fatty liver disease, body-mass index, and interventricular septum thickness in young men

“…Cardiac fibrosis is a well-known underlying mechanism of occurrence of fQRS in various cardiac pathologies. Bekar et al (28) showed fQRS as an independent predictor of EAT in hypertensive patients in their recent study. Yaman et al (11) showed that the presence of fQRS was associated with increased EAT in a healthy population.…”

The epicardial fat thickness is associated with fragmented QRS in patients with newly diagnosed metabolic syndrome

“…Myocardial fibrosis is a well-known underlying mechanism of fQRS occurrence in various cardiac pathologies 13 . Bekar et al demonstrated fQRS as an independent predictor of EFT in hypertensive patients in their recent study 22 . Yaman et al showed that the presence of fQRS was associated with increased EFT in healthy population 23 .…”

Retrospective evaluation of notched and fragmented QRS complex in dogs with naturally occurring myxomatous mitral valve disease

“…The present study aimed to evaluate the frequency of nQRS complexes and fQRS observed on ECG in dogs with naturally occurring MMVD and to assess the association between these electrocardiographic changes and disease severity. In human medicine, the presence of fQRS was associated with various cardiac conditions such as myocardial dysfunction, ischemic and non-ischemic cardiomyopathy, pulmonary hypertension, mitral valve stenosis, atrial septal defect, hypertrophic obstructive cardiomyopathy or Brugada syndrome (Heller et al 1996 ; Morita et al 2008 ; Das et al 2010 ; Yuce et al 2010 ; Bekar et al 2019 ; Bi et al 2020 ), therefore the presence of fQRS in ECG is accepted in human medicine as a marker of myocardial scar or fibrosis (Das et al 2010 ).…”

“…However, the association of these changes with the disease severity has not been investigated yet [3]. In human medicine, notching of the QRS complex has been studied in various cardiovascular diseases being associated with worse prognosis [4][5][6][7][8][9][10]. It was suggested that the alteration in QRS morphology is related to regional myocardial scar, leading to a conduction delay or a fragmentation of QRS complexes [11,12].…”

“…However, the association of these changes with the disease severity has not been investigated yet (Winter and Bates 2018 ). In human medicine, notching of the QRS complex has been studied in various cardiovascular diseases being associated with worse prognosis (Morita et al 2008 ; Yuce et al 2010 ; Bekar et al 2019 ; Bi et al 2020 ; Canpolat et al 2020 ; Tekin Tak et al 2020 ; Yooprasert et al 2020 ). It was suggested that the alteration in QRS morphology is related to regional myocardial scar, leading to a conduction delay or a fragmentation of QRS complexes (Flowers et al 1969 ; el-Sherif 1970 ).…”