Presence of fragmented QRS may be associated with complex ventricular arrhythmias in patients with type-2 diabetes mellitus

Imamura

Tada

et al. 2022

J of Diabetes Invest

Aims/Introduction Diastolic cardiac dysfunction in type 2 diabetes (DD2D) is a critical risk of heart failure with preserved ejection fraction. However, there is no established biomarker to detect DD2D. We aimed to investigate the predictive impact of fragmented QRS (fQRS) on electrocardiography on the existence of DD2D. Materials and Methods We included in‐hospital patients with type 2 diabetes without heart failure symptoms who were admitted to our institution for glycemic management between November 2017 and April 2021. An fQRS was defined as an additional R′ wave or notching/splitting of the S wave in two contiguous electrocardiography leads. DD2D was diagnosed according to the latest guidelines of the American Society of Echocardiography. Results Of 320 participants, 122 patients (38.1%) had fQRS. DD2D was diagnosed in 82 (25.6%). An fQRS was significantly associated with the existence of DD2D (odds ratio 4.37, 95% confidence interval 2.33–8.20; p < 0.0001) adjusted for seven potential confounders. The correlation between DD2D and diabetic microvascular disease was significant only among those with fQRS. Classification and regression tree analysis showed that fQRS was the most relevant optimum split for DD2D. Conclusions An fQRS might be a simple and promising predictor of the existence of DD2D. The findings should be validated in a larger‐scale cohort.

Section: Discussionsupporting

confidence: 89%

Fragmented QRS on electrocardiography as a predictor for diastolic cardiac dysfunction in type 2 diabetes

Imamura

Tada

et al. 2022

J of Diabetes Invest

“…In previous studies, significant elevation in the frequency of fQRS has been observed in diabetes mellitus, MetS and other diseases without obvious cardiovascular symptoms. Bayramoglu et al 24 reported a prevalence of fQRS of 28%, Eren et al 25 reported 37.5% among diabetes mellitus patients in a Turkish population and using coronary angiography, Mahfouz et al 26 reported 62% in Egyptian diabetes mellitus patients. In previous studies on MetS, 20% of patients showed fQRS in one study 27 , and 26.1% of MetS patients compared with 14.6% of control participants in another study 28 .…”

Section: Discussionmentioning

confidence: 99%

High prevalence of fragmented QRS on electrocardiography in Japanese patients with diabetes irrespective of metabolic syndrome

Nagata

Yamagami

et al. 2021

J of Diabetes Invest

Aims/Introduction: Fragmented QRS (fQRS) on electrocardiography is a marker of myocardial fibrosis and myocardial scar formation. This study aimed to clarify the relationship of fQRS with diabetes mellitus and metabolic syndrome (MetS) in Japanese patients. Materials and Methods: Approximately 702 individuals who had a routine health checkup at the Hokuriku Health Service Association (Toyama, Japan) in October 2014 were enrolled and categorized into one of the following four groups based on MetS and diabetes mellitus status: with diabetes mellitus (+) MetS+ (164 participants); diabetes mellitus+ without MetS (Mets-; 103 participants); diabetes mellitus-MetS+ (133 participants); and diabetes mellitus-MetS-(302 participants). fQRS was assessed using the results of electrocardiography. Results: The prevalence of fQRS was statistically higher in patients with diabetes melli-tus+ MetS+ (37%) and diabetes mellitus+ MetS-(35%), than those with diabetes mellitus-MetS+ (14%) or diabetes mellitus-MetS-(10%; P < 0.0001). Significant differences were observed between the fQRS(+) and fQRS(-) groups for age, sex, waist circumference, heart rate, hypertension, hemoglobin A1c, total cholesterol, MetS and diabetes mellitus. The area under the receiver operating characteristic curve for traditional risk factors and diabetes mellitus was 0.72 (P = 0.0007, 95% confidence interval 0.67-0.76), and for traditional risk factors and MetS it was 0.67 (P = 0.28, 95% confidence interval 0.62-0.72). Patients with diabetes mellitus had more than threefold higher likelihood of showing fQRS (odds ratio 3.41; 95% confidence interval 2.25-5.22; P < 0.0001) compared with the reference group without diabetes mellitus, after adjusting for age, sex, dyslipidemia, hypertension and waist circumference. Conclusions: fQRS was observed more frequently in diabetes mellitus patients than in MetS and control individuals. Diabetes mellitus was the most significant determinant for fQRS among MetS and other traditional metabolic risk factors.

“…In previous studies, signi cant elevation in the frequency of fQRS has been observed in DM, MetS, and other diseases without obvious cardiovascular symptoms. Bayramoglu et al reported a prevalence of fQRS of 28% [23], Eren et al reported 37.5% [24] among DM in a Turkish population and using coronary angiography, Mahfouz reported 62% in Egyptian DM [25]. In previous studies on MetS, 20% of patients showed fQRS in one study [26], and 26.1% of MetS patients compared to 14.6% of control subjects in another [27].…”

Section: Discussionmentioning

confidence: 92%

High prevalence of fragmented QRS on electrocardiography in Japanese subjects with diabetes irrespective of metabolic syndrome

Nagata

Yamagami

et al. 2020

Preprint

BackgroundFragmented QRS (fQRS) on electrocardiography is a marker of myocardial fibrosis and myocardial scar formation. fQRS has been reported as a reliable predictor of adverse cardiac events in several populations. We investigated the relationship of fQRS with diabetes mellitus (DM) and metabolic syndrome (MetS) in Japanese patients.Material and methodsOur study enrolled a total of 702 subjects (435 without DM and 267 with type 2 DM) who had a routine health checkup at the Hokuriku Health Service Association (Toyama, Japan) in October 2014. Based on MetS and DM status, participants were categorized into one of the following four groups: DM+ MetS + (157 subjects); DM+ MetS - (110 subjects); DM- MetS + (82 subjects); and DM- MetS- (353 subjects). fQRS was assessed using the results of electrocardiography.ResultsThe prevalence of fQRS was statistically higher in patients with DM+MetS+ (36%) and DM+MetS- (36%), than those with DM-MetS+ (18%) or DM-MetS- (9%) (p < 0.001). Significant differences were observed between the fQRS(+) and fQRS(-) groups for age, gender, waist circumference (WC), heart rate, hypertension, HbA1c, TC, MetS, and DM. The area under the receiver-operating curve for traditional risk factors and DM was 0.72 (p=0.0021, 95% confidence interval [CI]: 0.68-0.77), and for traditional risk factors and MetS it was 0.69 (p=0.1478, 95% CI: 0.64-0.73). Patients with DM had more than three-fold higher likelihood of showing fQRS (odds ratio, 3.41; 95% CI, 2.25-5.22; p<0.0001) compared to the reference group without DM, after adjusting for age, gender, dyslipidemia, hypertension, and WC.ConclusionfQRS was observed more frequently in DM than in MetS and control subjects. DM was the most significant determinant for fQRS among MetS and other traditional metabolic risk factors in the general Japanese population.