Relationship Between Fragmented QRS Complex and Long-Term Cardiovascular Outcome in Patients with Essential Hypertension

Abstract

Background : In patients with essential hypertension, fragmented QRS has been associated with many remodeling components that might lead to adverse cardiovascular effects. This study aimed to evaluate the relationship between fragmented QRS and adverse events and its potential long-term prognostic value. Methods: The patients with essential hypertension were divided into two groups according to the presence of fragmented QRS: fragmented QRS (+) and fragmented QRS (−). During long-term follow-up, the relationship of fragmented QRS to coronary artery disease, congestive heart failure, stroke, cardiovascular death, all-cause death, and major adverse cardiovascular and cerebrovascular events was evaluated. Results: The study group included 542 patients with essential hypertension. Fragmented QRS on ECG was observed in 224 (41.3%) patients. Considering the incidence rates at the end of 5.6 ± 1.3 years’ follow-up, the total incidence rate of major adverse cardiovascular and cerebrovascular events ( P < .001), coronary artery disease ( P < .001), and congestive heart failure ( P < .001) were higher in patients with fragmented QRS. No significant difference was observed between the two groups in terms of stroke ( P = .734), cardiovascular death ( P = 1), and all-cause death ( P = .574). As a result of multiple cox regression analysis, fragmented QRS ( P = .005) was identified as an independent predictor for major adverse cardiovascular and cerebrovascular events development. Conclusion: In patients with hypertension, the presence of fragmented QRS was found as an independent predictor for major adverse cardiovascular and cerebrovascular events development.

Evaluation of cardiac electromechanics in patients with newly diagnosed hypertension

“…However, accessibility, labor, shortage of trained personnel, and resource constraints mean that using strain echocardiography on every patient is challenging. Many demographic, biochemical, echocardiographic, and part of ECG findings have been shown to correlate with LV dysfunction in various diseases [8,[21][22][23]. In consistent with these studies, CRP level, LVEDD, and overall daytime and nighttime higher SBPs, nighttime higher DBP levels were associated with subclinical LV systolic dysfunction in patients with newly diagnosed hypertension.…”

Premature electrical activity or extreme QRS fragmentation? When early is too late!

“…QRS fragmentation (fQRS) has been confirmed as an additional sign in patients with acute myocarditis and persistence of fQRS was associated with ongoing inflammation and with poor outcome 6,7 . The same association with worse prognosis has been documented in many other diseases such as cardiac Amyloidosis Light chain amyloidosis as well as in patients with hypertension or after an acute myocardial infarction 8–10 . However, in infiltrative heart diseases the QRS increases in duration but no such QRS splitting appears.…”

“…6,7 The same association with worse prognosis has been documented in many other diseases such as cardiac Amyloidosis Light chain amyloidosis as well as in patients with hypertension or after an acute myocardial infarction. [8][9][10] However, in infiltrative heart diseases the QRS increases in duration but no such QRS splitting appears.…”

The association between frontal QRS-T angle and reverse dipper status in newly diagnosed hypertensive patients

“…Several ECG parameters, particularly fragmented QRS, QT dispersion (QTd), and corrected QTd, have been studied in patients with cardiovascular diseases and hypertension [10][11][12]. The spatial QRS-T angle defined as the angle formed by the directions of ventricular depolarization (QRS wave) and repolarization (T wave), has been proposed as a unique marker of ventricular repolarization [13].…”