QRS fragmentation as possible new marker of fibrosis in patients with myocarditis. Preliminary validation with cardiac magnetic resonance

Ferrero, Paolo; Piazza, Isabelle; Grosu, Aurelia; Brambilla, Paolo; Sironi, Sandro; Senni, Michele

doi:10.1002/ejhf.1413

Cited by 16 publications

(29 citation statements)

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“…13 In the subset of patients who had undergone CMR, similarly to ischaemic and non-ischaemic cardiomyopathy, fQRS and LGE distribution appeared correlated, confirming our preliminary observation. 9,14 Interestingly, persistence of fQRS was also significantly correlated with evidence of ongoing disease at biopsy, supporting the pathophysiologic link between histological fQRS as a diagnostic marker and electrical changes in this particular model of structural disease. If confirmed on larger samples, fQRS might be used as a simple clinical bedside tool to support the initial suspect of AM and to predict histological persistence of disease, which has been recognized as a detrimental prognostic factor.…”

Section: Discussionmentioning

confidence: 56%

“…In a series of patients in previously published data, we observed that fQRS consistently mirrored the evidence and persistence of LGE on the CMR. 9 In that preliminary report, diagnosis of AM was based on clinical finding and CMR. In the present analysis, we included a group of patients with biopsy-proven myocarditis from another centre in which the observation of fQRS in both the acute phase and at follow-up was confirmed.…”

Section: Discussionmentioning

confidence: 99%

“…6 We have previously described the association of fQRS with late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) in patients with AM referred to a single centre. 9 This study aims to validate the observation of fQRS as additional electrocardiographic diagnostic sign on a larger cohort of patients with AM, including a subgroup with biopsy-proven disease. We also sought to investigate if persistence of fQRS might predict ongoing structural changes at biopsy or CMR at follow-up.…”

Section: Introductionmentioning

confidence: 99%

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QRS fragmentation as a possible electrocardiographic diagnostic marker in patients with acute myocarditis: preliminary histopathological validation

et al. 2020

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Aims We aim to assess the reproducibility of QRS fragmentation (fQRS) on a multi-centre dataset of patients with acute myocarditis (AM), including a histopathological validation in a subgroup with biopsy-proven disease. Electrocardiogram (ECG) in patients with myocarditis is usually considered aspecific. ST changes and conduction anomalies have been commonly reported so far. We have previously described fQRS in patients with AM. Methods and results Patients admitted between 2008 and 2019 in two centres with a diagnosis of AM were included. Standard ECG, echocardiography, and cardiac magnetic resonance (CMR) findings were recorded at baseline and at follow-up (FU). Eighty patients were analysed, 66 men (82%), with median age of 34 (26-43) years. Twenty-two patients had biopsy-proven AM. At presentation, 61 patients (76%) displayed fQRS. Median ejection fraction (EF) was 55% (43-60). Seventy-two patients (90%) underwent CMR and displayed late gadolinium enhancement (LGE). ECG leads showed that fQRS correlated with distribution of LGE. In patients with positive biopsy, fQRS was present in 18 (81%). Median FU was 419 days (224-956). Complete FU was available for 64 patients (80%), and 33 patients (52%) displayed persistence of fQRS. Median EF was 60% (57-64). Eleven patients underwent a repeated biopsy at FU, eight of whom had persistent inflammation and fQRS. Fifteen patients (23%) had ventricular tachycardia, 14 of whom still showed fQRS. Conclusions In this cohort fQRS was confirmed as an additional useful ECG sign. Persistence of fQRS was associated with ongoing inflammation and with a poorer outcome in terms of ventricular function and occurrence of arrhythmias.

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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QRS fragmentation as a possible electrocardiographic diagnostic marker in patients with acute myocarditis: preliminary histopathological validation

et al. 2020

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“…10,12 QRS fragmentation was acutely present in 57% and persisted in 33% of patients confirming previous preliminary observation in adult population. 6 QRS fragmentation is a simple electrocardiogram marker already described in other heart diseases and is deemed to be the expression of local slowing and anisotropic electrical conduction. 13 In patients with myocarditis, similarly to other heart disease, in which QRS fragmentation has been well described, this sign might be the epiphenomenon of local slowed and anisotropic electrical conduction.…”

Section: Discussionmentioning

confidence: 99%

“…5 We have previously described the presence of QRS fragmentation correlating with evidence of late gadolinium enhancement in a series of adult patients with acute myocarditis. 6 QRS fragmentation, defined of multiples R spikes, has been widely reported as a marker of myocardial fibrosis in different heart disease and has a recognised prognostic value. [7][8][9] This study aims to confirm this finding in a single-centre cohort of children who were eventually diagnosed with acute myocarditis.…”

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QRS fragmentation in children with suspected myocarditis: a possible additional diagnostic sign

Ferrero

Piazza

2020

Cardiol Young

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AbstractAims:We aim to assess the diagnostic role of QRS fragmentation in children with suspected acute myocarditis.Background:Diagnosis of myocarditis in the paediatric population is challenging. Clinical suspicion, electrocardiogram, and laboratory tests are the main diagnostic features at presentation. However, electrocardiogram in patients with myocarditis is usually considered aspecific. We have previously described QRS fragmentation in adult patients with acute myocarditis.Methods:Patients aged less than 18 years, admitted between 2003 and 2019, and discharged with a diagnosis of acute myocarditis were included. Standard electrocardiogram, laboratory, and echocardiographic findings at admission and follow-up were reviewed. QRS fragmentation was defined by the presence of multiphasic R′ spikes. Cardiac magnetic resonance and biopsy were performed in selected patients.Results:Twenty-one patients were analysed, 16 males (76%), median age 9.5 (2.5–16) years. At presentation, 12 patients (57%) displayed QRS fragmentation. Median ejection fraction was 40% (27–60). Nine patients (43%) underwent cardiac magnetic resonance and displayed late gadolinium enhancement. One patient underwent biopsy that showed borderline findings. Electrocardiogram leads showing QRS fragmentation correlated with distribution of late gadolinium enhancement. Median follow-up was 600 (190–2343) days. All patients were alive at last follow-up. Six patients (33%) patients displayed persistence of QRS fragmentation. Median ejection fraction was 60% (60–65%). In three patients (14%), ejection fraction remained depressed, two of which showed persistence of QRS fragmentation.Conclusion:In this cohort of children with suspected myocarditis, QRS fragmentation was confirmed as a new additional diagnostic finding to look for at admission and during follow-up.

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Four‐dimensional speckle tracking echocardiography and fragmented QRS in detection of early left ventricular systolic dysfunction in patients with subclinical hyperthyroidism

Karaca¹,

Karasu²,

Taşolar

et al. 2023

J of Clinical Ultrasound

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Background Thyroid disorders are associated with many cardiovascular risk factors. The importance of thyroid hormones in the pathophysiology of heart failure is underlined by the European guidelines of the European Society of Cardiology. However, the role of subclinical hyperthyroidism (SCH) in subclinical left ventricular (LV) systolic dysfunction is not entirely clear. Methods This cross‐sectional study included 56 SCH patients and 40 healthy volunteers. The 56 SCH group was divided into two subgroups depending on the presence of fragmented QRS (fQRS). In both groups, left ventricular global area strain (LV‐GAS), global radial strain (GRS), global longitudinal strain (GLS), and global circumferential strain (GCS) were obtained with four‐dimensional (4D) echocardiography. Results GAS, GRS, GLS, and GCS values were significantly different in SCH patients and in healthy volunteers. GLS and GAS values were lower in the fQRS+ than in the fQRS− group (−17.06 ± 1.00 vs. −19.08 ± 1.71, p < .001, and −26.61 ± 2.38 vs. −30.61 ± 2.57, p < .001, respectively). ProBNP was positively correlated with LV‐GLS (r = 0.278, p = .006) and LV‐GAS (r = 0.357, p < .001). Multiple linear regression analysis showed that fQRS was an independent predictor of LV‐GAS. Conclusions 4D strain echocardiography may be helpful for the prediction of early cardiac dysfunction in patients with SCH. The presence of fQRS may be an indicator of subclinical LV dysfunction in SCH.

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QRS fragmentation as possible new marker of fibrosis in patients with myocarditis. Preliminary validation with cardiac magnetic resonance

Cited by 16 publications

References 4 publications

QRS fragmentation as a possible electrocardiographic diagnostic marker in patients with acute myocarditis: preliminary histopathological validation

QRS fragmentation as a possible electrocardiographic diagnostic marker in patients with acute myocarditis: preliminary histopathological validation

QRS fragmentation in children with suspected myocarditis: a possible additional diagnostic sign

Four‐dimensional speckle tracking echocardiography and fragmented QRS in detection of early left ventricular systolic dysfunction in patients with subclinical hyperthyroidism

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