Usefulness of Fragmented QRS on a 12-Lead Electrocardiogram in Acute Coronary Syndrome for Predicting Mortality

Das, Mithilesh K.; Michael, Mark A.; Suradi, Hussam; Peng, Jonathan A.; Sinha, Anjan; Shen, Changyu; Mahenthiran, Jo; Kovacs, Richard J.

doi:10.1016/j.amjcard.2009.07.046

Cited by 146 publications

(121 citation statements)

References 30 publications

Supporting

Mentioning

109

Contrasting

Unclassified

Order By: Relevance

“…Unadjusted rates of event-free survival on Kaplan-Meier plots were similar between the fQRS groups (stratified log-rank statistic probability value of 0.15) (Figure). Arrhythmic deaths were seen in 99 (11.8%) patients and were similar between those in whom fQRS was present (27 deaths [9 When considering only patients with a prior ICD implant, rates of death from all causes were similar between patients in whom fQRS was present (20.9%) and absent (22.7%); Pϭ0.67) ( Table 3). Similarly, among patients without a prior ICD implant, rates of death from all causes were similar between patients in whom fQRS was present (18.2%) and absent (25.5%; Pϭ0.11).…”

Section: Unadjusted Analysesmentioning

confidence: 71%

“…Pathophysiologically, fragmented QRS has been associated with regional myocardial scar, 6 -8 which is believed to be a substrate for ventricular arrhythmia. Clinically, fQRS has been associated with an increased mortality risk in patients with acute myocardial infarction, 9 higher rates of spontaneous ventricular fibrillation among patients with Brugada syndrome, 10 and to be of comparable prognostic value as potentials among patients with arrhythmogenic right ventricular dysplasia. 11 In a population referred for stress testing, fQRS was associated with higher rates of cardiac events 12 and, more recently, in patients with a wide QRS (Ն120 ms), fQRS was found to be an independent predictor of all-cause mortality.…”

Section: Clinical Perspective On P 344mentioning

confidence: 99%

See 1 more Smart Citation

Fragmented QRS and Mortality Risk in Patients With Left Ventricular Dysfunction

Cheema

Khalid

Wimmer

et al. 2010

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

Background-Fragmented QRS (fQRS) has been shown to predict cardiac events in select patient populations. Whether fQRS improves patient selection for primary prevention patients eligible for implantable cardioverter-defibrillator (ICD) therapy remains unknown. Methods and Results-In a prospective, multisite cohort of 842 patients with left ventricular dysfunction (ejection fraction Յ35%) representing both ischemic and nonischemic etiology, the presence of fQRS on ECG was assessed using standardized criteria. The association between fQRS and all-cause and arrhythmic mortality was evaluated overall and stratified by ICD status using

show abstract

Section: Unadjusted Analysesmentioning

confidence: 71%

Section: Clinical Perspective On P 344mentioning

confidence: 99%

Fragmented QRS and Mortality Risk in Patients With Left Ventricular Dysfunction

Cheema

Khalid

Wimmer

et al. 2010

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

show abstract

“…24) Acute myocardial inflammation and myocardial ischemia may lead to cardiac remodeling that is associated with the fQRS. 25,26) In this study, there was a higher number of fQRS in patients in the deceased group than in the survival group, even though fQRS was not a potential independent biomarker. Although the main underlying pathophysiological mechanisms between the fQRS and Stanford type A AAD were not elucidated in previous studies, we suspected that the splitting of the aortic root wall caused by a tear in the intima layer decreased the regional myocardial blood flow and myocardial perfusion.…”

Section: Discussionmentioning

confidence: 84%

Biomarkers Investigation for In-Hospital Death in Patients With Stanford Type A Acute Aortic Dissection

et al. 2016

View full text Add to dashboard Cite

SummaryThis retrospective study aimed to investigate the predictive value of biomarkers for in-hospital mortality of patients with Stanford type A acute aortic dissection (AAD).AAD is a life-threatening disease with an incidence of about 2.6-3.6 cases per 100,000/year. A total of 67 consecutive Stanford type A AAD patients admitted to hospital were divided into a deceased group and survival group. The baseline information of the patients between two groups was systematically compared, followed by examination of the electrocardiograms (ECG). Based on the follow-up during hospitalization, we investigated the simultaneous assessment of indexes like fragmented QRS complex (fQRS), admission systolic blood pressure (SBP), aortic diameter, surgical management, troponin I (TnI), white blood cell (WBC) count, N-terminal pro-brain natriuretic peptide (NT-proBNP), and D-dimer.The levels of TnI and NT-proBNP, WBC counts, and rate of fQRS (+) in patients of the deceased group were significantly higher than those in the survival group. The male sex (hazard ratio, 10.88; P = 0.001), admission SBP (hazard ratio, 0.98; P = 0.012), NT-proBNP (hazard ratio, 1.00; P = 0.001), and WBC count (hazard ratio, 1.10; P = 0.033) were independently related with in-hospital death. As a single marker, WBC count had the highest sensitivity at 84.6% (specificity 65.9%).Admission SBP, NT-proBNP, and WBC count were potential independent risk factors of in-hospital death in Stanford type A AAD patients. WBC count may be a more accurate predictor of type A AAD than either alone. (Int Heart J 2016; 57: 622-626)

show abstract

“…These fragmentations on surface ECG were associated with increased adverse cardiovascular events (CVEs) in previous studies (2)(3)(4)(5). The reason of documented association between fragmented QRS (fQRS) and increased morbidity and mortality, sudden cardiac death and recurrent CVEs were investigated by several studies (4)(5)(6)(7)(8)(9)(10).…”

Section: Introductionmentioning

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

View full text Add to dashboard Cite

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...

show abstract

Usefulness of Fragmented QRS on a 12-Lead Electrocardiogram in Acute Coronary Syndrome for Predicting Mortality

Cited by 146 publications

References 30 publications

Fragmented QRS and Mortality Risk in Patients With Left Ventricular Dysfunction

Fragmented QRS and Mortality Risk in Patients With Left Ventricular Dysfunction

Biomarkers Investigation for In-Hospital Death in Patients With Stanford Type A Acute Aortic Dissection

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

Contact Info

Product

Resources

About