The RSR′ complex not related to right bundle branch block: Diagnostic value as a sign of myocardial infarction scar

Varriale, Philip; Chryssos, Basil E.

doi:10.1016/0002-8703(92)90648-f

Cited by 75 publications

(50 citation statements)

References 20 publications

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“…Myocardial ischemia is a well-known cause of heart failure and ventricular arrhythmias due to the development of scar tissue, which is related to increased mortality and morbidity (6,23,30,34). In patients with an acute coronary syndrome, heterogeneous depolarization of myocardium caused by ischemia and infarction may be the main determinant for increased arrhythmic events during the hospital care.…”

Section: Discussionmentioning

confidence: 99%

Fragmented QRS may predict postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass graft surgery

Çetin¹,

Kocaman²,

Durakoğlugil³

et al. 2012

Anadolu Kardiyol Derg

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Fragmented QRS may predict postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass graft surgery Fragmente QRS izole koroner arter baypass greftleme operasyonu geçiren hastalarda postoperatif atriyal fibrilasyon gelişimini öngörebilir ABSTRACTObjective: Fragmented QRS complexes (fQRS) are defined as various RSR′ patterns in 2 contiguous leads corresponding to a major coronary artery territory. Although the reason of association between fQRS and cardiac events was documented as cardiac fibrosis, the predictive role of fQRS was not studied for postoperative atrial fibrillation (POAF) which is a frequent and serious complication in patients undergoing isolated coronary artery bypass graft (CABG) surgery. Therefore, this issue was investigated in the present study. Methods: The current study has a prospective observational design. Two hundred and seventy two eligible patients who underwent isolated CABG surgery were enrolled consecutively. The patients were divided in two groups with post-op atrial fibrillation (AF) and non-AF. The occurrence of new-onset AF following CABG and the relationship with fQRS were searched. The logistic regression analysis was used to determine independent predictors for POAF. The sensitivity and specificity of study variables in predicting POAF were calculated using a receiver-operating characteristic curve (ROC). Results: POAF occurred in 62 of 272 patients (22.8%). Patients with POAF were generally older (p<0.001) and female (p=0.006), with preexisting hypertension (p=0.008), lower hemoglobin levels (p=0.011), chronic obstructive lung disease (p=0.003), prolonged QRS time (p=0.004), and higher EUROSCORE (p<0.001) compared to non-AF patients. Patients with POAF had lower left ventricular ejection fraction (p<0.001) and high fQRS rate (p<0.001), but similar left atrial size (LA, p=NS). Interestingly, LA size was significantly enlarged in patients with fQRS (3.8±0.6 vs. 4.1±0.5 cm, p=0.002). In addition, the patients with POAF had prolonged stay in the cardiac surgery intensive-care unit (p<0.001) and extended in-hospital care (p=0.001). New-onset POAF was significantly related to the presence and number of fQRS. In the logistic regression analysis, only age (OR: 1.044, 95% CI: 1.008-1.082, p=0.016), female gender (OR: 2.347, 95% CI: 1.079-5.106, p=0.031), the presence and number of fQRS (OR: 6.020, 95% CI: 3.152-11.5 and OR: 1.522, 95% CI: 1.282-1.807, both of, p<0.001) were independent predictors of POAF. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and the diagnostic accuracy (DA) of presence of fQRS on pre-op electrocardiogram to predict POAF were 66%, 76%, 45%, 88% and 74%, respectively. The area under ROC was found as 0.733 (p<0.001, 95% CI: 0.657-0.810). Conclusion: In our study, we found that new-onset POAF was independently related to the presence and number of fQRS in patients undergoing CABG surgery. In addition, fQRS on pre-op surface ECG had high predictive values for new-onset POAF. (Anadolu Kard...

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Section: Discussionmentioning

confidence: 99%

Fragmented QRS may predict postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass graft surgery

Çetin¹,

Kocaman²,

Durakoğlugil³

et al. 2012

Anadolu Kardiyol Derg

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“…marker of depolarization abnormality and myocardial scar in patients with coronary artery disease (Varriale and Chryssos 1992;Das et al 2006;Michael et al 2007;Das et al 2009). Additionally, fQRS has been demonstrated as a marker of increased mortality and arrhythmic events in patients with ischemic cardiomyopathy ), arrhythmogenic right ventricular dysplasia/cardiomyopathy (Peters et al 2008) and Brugada syndrome (Morita et al 2008).…”

Section: Discussionmentioning

confidence: 99%

Fragmented QRS Is Predictive of Myocardial Dysfunction, Pulmonary Hypertension and Severity in Mitral Stenosis

Yüce

Davutoğlu

Ozbala

et al. 2010

Tohoku J. Exp. Med.

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“…Twenty-five studies were excluded as they were letters to editors, case reports, or narrative review articles. Two studies [6,7] were excluded because they had worked on wide fragmented complexes that were excluded according to Das criteria [5]. And one study was excluded because the researchers assessed the correlation between fQRS and left ventricular aneurysm instead of myocardial scar [8].…”

Section: Discussionmentioning

confidence: 99%

“…A classic fQRS is only a narrow complex with duration less than 120 ms [16]. According to this definition, we did not include in our systematic review the diagnostic studies that consisted of wide fragmented complexes [6,7]. It seems that specific studies to evaluate the wide fragmented complexes as a surrogate of MI are needed.…”

Section: Fragmented Qrs Vs F-w-qrs Complexesmentioning

confidence: 99%

Diagnostic value of fragmented QRS complex in myocardial scar detection: systematic review and meta-analysis of the literature

et al. 2016

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A b s t r a c t Background and aim:The present study aimed to investigate the diagnostic value of fragmented QRS complex (fQRS) on 12-lead electrocardiogram (ECG) for myocardial scar detection, and presented the results in a systematic review and meta-analysis format.Methods: Medline, SCOPUS, and ISI Web of Knowledge were searched electronically with "Fragmented QRS" or "fQRS" as key words. All related studies that had evaluated the accuracy of fQRS for myocardial scar diagnosis were included.Results: Eight studies (2560 patients) were finally included in the systematic review. Specificity assessment could be evaluated only by five out of these eight articles. Overall pooled sensitivity of fQRS, Q wave, and mixed Q-fQRS was 68% (65-71), 51% (47-55), and 74% (69-79) and the pooled specificity was 80% (79-81), 97% (97-98) and 92% (91-93), respectively. Conclusions:Fragmented QRS is a novel ECG marker with more sensitivity and less specificity than Q wave. A combination of fQRS with Q wave in a 12-lead ECG results in up to 74% sensitivity and 92% specificity. Additional studies are needed to assess the significance of this ECG parameter for regional myocardial scar detection.

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The RSR′ complex not related to right bundle branch block: Diagnostic value as a sign of myocardial infarction scar

Cited by 75 publications

References 20 publications

Fragmented QRS may predict postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass graft surgery

Fragmented QRS may predict postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass graft surgery

Fragmented QRS Is Predictive of Myocardial Dysfunction, Pulmonary Hypertension and Severity in Mitral Stenosis

Diagnostic value of fragmented QRS complex in myocardial scar detection: systematic review and meta-analysis of the literature

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