The Presence of Fragmented QRS on 12-Lead Electrocardiography in Patients with Coronary Artery Ectasia

Abstract

Background and ObjectivesCoronary artery ectasia (CAE) is an angiographic finding characterized by dilation of an arterial segment with a diameter at least 1.5 times that of its adjacent normal coronary artery. Fragmented QRS (fQRS) complexes are electrocardiographic signals which reflect altered ventricular conduction around regions of a myocardial scar and/or ischaemia. In the present study, we aimed to evaluate the presence of fQRS in patients with CAE.Subjects and MethodsThe study population included 100 patients with isolated CAE without coronary artery disease (CAD) and 80 angiographically normal controls. fQRS was defined as the presence of an additional R wave or notching of R or S wave or the presence of fragmentation in two contiguous leads corresponding to a major coronary artery territory.ResultsThe two groups were similar in terms of age, sex, hypertension, dyslipidemia, and family history of CAD. The presence of fQRS was significantly (p<0.05) higher in the CAE group than that in the normal coronary artery group (29% vs. 6.2%, p=0.008). Isolated CAE were detected most commonly in the right coronary artery (61%), followed by left anterior descending artery (52%), left circumflex artery (36%), and left main artery (9%). Multivariate stepwise logistic regression analysis showed that CAE {odds ratio (OR) 1.412; 95% confidence interval (CI) 1.085-1.541; p=0.003} and diabetes (OR 1.310; 95% CI 1.025-1.482; p=0.041) were independently associated with fQRS.ConclusionThe presence of fragmented QRS associated with increased risk for arrhythmias and cardiovascular mortality was significantly higher in patients with CAE than in patient with normal coronary artery. Further studies are needed to determine whether the presence of fragmented QRS is a possible new risk factor for patients with CAE.

Role of QRS fragmentation in 12-lead surface ECG in prediction of isolated epicardial coronary artery ectasia and its anatomical distribution in patients without acute coronary syndromes

“…To our knowledge, the study done by Sen et al was the only study that discussed the correlation between fQRS and isolated CAE. They found that fQRS is significantly more found in patients with isolated CAE than in patients with normal coronaries [39]. fQRS is more frequently seen in patients with slow coronary flow which is an indicator of microvascular dysfunction [40].…”

Fragmentation of the QRS complex in patients with acute coronary syndrome treated invasively

“…The presence of f-QRS ECG was associated with a heterogeneous, "zig-zag" scar formed around the conduction within the myocardium [3]. Earlier studies have shown that f-QRS is a valuable predictor of MI, malignant cardiac arrhythmias, left ventricular dysfunction, and coronary artery ectasia [9,10].…”

Hypertension and coronary artery ectasia: a systematic review and meta-analysis study

“…The obtained articles were reviewed by two authors and confirm with a third person. As mentioned in Table 1, the results examined for risk of bias for studies based on the MMAT, all studies had an acceptable quality for inclusion in the study and according to the "quantitative non-randomized" part of the checklist, eight studies had a low risk of bias [18,19,25,40,41,47,50,52], 27 studies had a moderate risk of bias [5-11, 16, 17, 22-24, 26, 28, 29, 33, 34, 36, 38, 39, 43-46, 48, 49, 51], and five studies had a high risk of bias [27,30,35,37,42].…”

“…This performance is called common shear stress [2,14] and it would be increased by HTN [15]. Also, HTN has been suggested as a risk factor for CAE [10,[16][17][18][19]. HTN is a global problem, especially in developing countries [20].…”