The Prognostic Significance of Narrow Fragmented QRS on Admission Electrocardiogram in Patients Hospitalized for Decompensated Systolic Heart Failure

Abstract

Background: Narrow fragmented QRS (fQRS) has recently been recognized as a significant predictor of prognosis in various cardiovascular diseases. Hypothesis: We hypothesized that the presence of narrow fQRS on admission electrocardiogram (ECG) in patients with decompensated systolic heart failure (HF) of any cause would be associated with long-term prognosis. Methods: Patients hospitalized for decompensated HF due to ischemic or nonischemic dilated cardiomyopathy (left ventricular ejection fraction <35%) were retrospectively analyzed. The primary clinical end points were cardiovascular mortality, sudden cardiac death, and rehospitalization for HF. Results: The mean duration of follow-up was 3.73 ± 1.41 years. Patients were classified as fQRS(+) group (n = 114; mean age, 63.49 ± 12.04 years) and fQRS(−) group (n = 113 patients; mean age, 65.04 ± 11.95 years). fQRS on ECG was significantly correlated with New York Heart Association (NYHA) functional class (P = 0.001). In multivariate Cox proportional hazard analysis, narrow fQRS (odds ratio [OR]: 3.130, 95% confidence interval [CI]: 1.560-2.848, P = 0.001), chronic renal failure (OR: 2.455, 95% CI: 1.120-5.381, P = 0.025), NYHA class (OR: 8.305, 95% CI: 2.568-26.855, P < 0.0001), and hypoalbuminemia (OR: 2.099, 95% CI: 1.122-3.926, P = 0.020) were independent predictors of cardiovascular mortality. In Kaplan-Meier survival analysis, narrow fQRS on admission ECG predicted worse survival rate at 84 months; survival probability significantly decreased in the fQRS(+) group compared with fQRS(−) group (P < 0.0001). Conclusions: Presence of narrow fQRS is associated with worse NYHA functional class in patients hospitalized for decompensated HF. Narrow fQRS predicts cardiovascular mortality in a specific subgroup of systolic HF patients, namely those hospitalized for decompensated HF of both ischemic and nonischemic causes.

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

“…As we can see (Table 1), the proportion of patients with fragmentation is reduced from 69% to 64%, but it increases again to 71% at discharge, which may be indicative of the instantaneous local improvement of MI. Based on the results of the study, we noticed that a reduced LVEF below 35% combined with the presence of f-QRS has a value of bad prognosis, which confirmed earlier studies [14]. In the tion of narrow QRS (< 120 ms) is defined as an additional R (R') wave or an incision within the S wave or the presence of at least 2 R-waves in two contiguous leads corresponding to the area by the relevant vasculature coronary artery [9].…”

Fragmented QRS on Admission Electrocardiography Predicts Long‐Term Mortality in Patients with Non–ST‐Segment Elevation Myocardial Infarction

“…24 In patients with heart failure, as the New York Heart Association (NYHA) class increases, the risk of cardiovascular mortality also increase. 24 In patients with heart failure, as the New York Heart Association (NYHA) class increases, the risk of cardiovascular mortality also increase.…”

The relationship between fragmented QRS complexes and SYNTAX and Gensini scores in patients with acute coronary syndrome

“…The specific cause of this fractionation on surface ECG and the determinants of this phenomenon are not fully known. Numerous studies have demonstrated that fQRS is associated with increased morbidity and mortality and is also a predictor of adverse cardiac events in patients with ACS [17][18][19], idiopathic dilated [20], and decompensated heart failure [21]. Theoretically, fQRS is generally agreed to be derived from regional myocardial fibrosis/scar and ischaemia, which cause heterogeneous myocardial electrical activation [22][23][24].…”