The presence of fragmented QRS on 12-lead ECG in patients with coronary slow flow

Abstract

A b s t r a c tBackground: Coronary slow flow (CSF) is characterised by delayed opacification of coronary arteries in the absence of epicardial occlusive disease. It has been reported that CSF may cause angina, myocardial ischaemia, and infarction. Fragmentation of QRS complex (fQRS) is an easily evaluated non-invasive electrocardiographic parameter. It has been associated with alternation of myocardial activation due to myocardial scar and/or ischaemia. Whether CSF is associated with fQRS is unknown. The presence of fQRS on ECG may be an indicator of myocardial damage in patients with CSF. Aim:To investigate the presence of fQRS in patients with CSF.Methods: Sixty patients (mean age 55.5 ± 10.5 years) with CSF and 44 patients with normal coronary arteries without associated CSF (mean age 53 ± 8.4 years) were included in this study. The 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.Results: The presence of fQRS was higher in the CSF group than in the controls (p = 0.005). Hypertension was significantly more common in the CSF group (p < 0.001). There was no significant association between the presence of fQRS and an increasing number of vessel involvements. Logistic regression analysis demonstrated that the presence of CSF was the independent determinant of fQRS (OR = 10.848; 95% CI 2.385-49.347; p = 0.002). Conclusions:Fragmented QRS, indicating increased risk for arrhythmias and cardiovascular mortality, was found to be significantly higher in patients with CSF. We have not found an association between the presence of fragmented QRS and the degree of CSF. Further prospective studies are needed to establish the significance as a possible new risk factor in patients with CSF.

Prognostic Value of QRS Fragmentation in Patients with Acute Myocardial Infarction: A Meta‐Analysis

“…1,2 Correlation and prognostic importance of presence of fQRS on ECG have been shown in various cardiovascular diseases such as cardiomyopathy, coronary slow flow, left ventricular noncompaction, and Brugada syndrome. [3][4][5][6][7] In addition, various studies have evaluated the prognostic importance of fQRS in patients with acute coronary syndrome (ACS), ST-segment elevation (STEMI), or non-ST segment elevation myocardial infarction (NSTEMI). [8][9][10][11][12][13][14][15][16][17][18] Some recent papers reviewed the clinical importance of fQRS in patients with cardiovascular diseases.…”

The Predictive Value of Admission Fragmented QRS Complex for In‐Hospital Cardiovascular Mortality of Patients with Type 1 Acute Aortic Dissection

“…The presence of fQRS was demonstrated to be an independent predictor of decreased myocardial perfusion and left ventricular function in patients with ischemic heart disease . Moreover, fQRS, which may be widened or narrowed, has been reported to be related with high mortality and morbidity, including hemodynamically significant arrhythmic events in coronary artery disease, coronary slow flow, acute coronary syndromes, ischemic and nonischemic cardiomyopathies, hypertrophic obstructive cardiomyopathy, and decompensated systolic heart failure . In this study, the predictive value of admission fQRS complex for in‐hospital adverse cardiovascular events in patients with a type 1 AAD was investigated.…”

“…The presence of fQRS was demonstrated as an independent predictor of decreased myocardial perfusion and left ventricular function in patients with ischemic heart disease . Furthermore, the prognostic predictive value of fQRS for other cardiovascular diseases has also been reported …”

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

“…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]. This association between fQRS and coronary slow flow was discussed in some studies as that was done by Mittal [41].…”