Usefulness of fragmented QRS in hypertensive patients in the absence of left ventricular hypertrophy

Abstract

In the absence of left ventricular hypertrophy, importance of fragmented QRS complex (fQRS) in individuals with hypertension is unknown. The authors aimed to evaluate the relationship between blood pressure levels and fQRS in the absence of left ventricular hypertrophy. A total of 548 never-treated patients who underwent 24-hour ambulatory blood pressure monitoring were enrolled. The frequency of fQRS was significantly higher in patients with hypertension than normotension (36.4% vs 17.6%, P<.05). Multivariate logistic regression analysis revealed that systolic blood pressure is significantly associated with presence of fQRS on electrocardiography fQRS may be a sign of increased blood pressure and may predict higher fibrotic burden in patients with hypertension. | INTRODUCTIONThere is a strong correlation between increased blood pressure (BP) levels and cardiovascular events. 1 Despite the estimated prevalence of hypertension of ≈30% to 45% of the general population, the presence of difficulties in the diagnosis and treatment causes an inability to control and monitor the condition. 2 Electrocardiography (ECG) plays an important role in the monitoring of patients with hypertension; however, ECG abnormalities seem to mainly be the sign of left ventricular hypertrophy (LVH) and increased left ventricular mass caused by chronic pressure overload. 3 BP elevation is an important cause of fibrotic burden in myocardium, and chronic pressure overload related to collagen synthesis is the main reason for fibrosis in individuals with hypertension. 4 However, progression from early-stage fibrosis to manifest LVH as end organ damage is likely a lengthy process. A narrow fragmented QRS complex (fQRS) as a ventricular conduction abnormality is a sign of myocardial fibrosis and is associated with adverse outcomes in various cardiovascular diseases. 5-7 Therefore, presence of fQRS on ECG, as an indicator of myocardial fibrosis, may be a sign of increased BP even in the absence of manifest LVH. In the present study, we aimed to investigate whether increased BP levels have a positive correlation with the presence of fQRS on ECG in the absence of LVH and to demonstrate the usefulness of fQRS before the development of LVH. | METHODS | Study participantsIn all, 614 consecutive patients who were never treated and referred to our outpatient clinic for suspicion of hypertension and underwent 24-hour ambulatory BP monitoring (ABPM) between July 2015 and July 2016 were enrolled. Patients with LVH (n=24), previous myocardial infarction and/or coronary artery bypass graft surgery (n=13), complete or incomplete bundle branch block and QRS duration ≥120 ms (n=11), left ventricular ejection fraction <50% (n=10), and moderate to severe valvular heart disease (n=8) were excluded. As a result, the remaining 548 patients were included in the study. All individuals were evaluated with a detailed anamnesis, physical examination, laboratory analysis, echocardiography, and ECG. LVH was defined according to electrocardiographic modified Sokolow-Lyon in...

Association Between Non-Dipping and Fragmented QRS Complexes in Prehypertensive Patients

“…6 - 8 Additionally, fQRS is a well described fibrotic factor in hypertension. 11 , 16 It has been demonstrated that the frequency of fQRS is significantly higher in hypertensive patients than in normotensives, 9 and non-dipper hypertensive patients have higher frequency of fQRS on ECG compared to hypertensive dippers. 10 , 11 These studies revealed that increased blood pressure levels and elevated nighttime blood pressure levels are associated with the presence of fQRS on ECG in hypertensive patients, which indicates the higher fibrotic burden within myocardium in these patients.…”

“…8 Importantly, increased blood pressure is associated with presence of fQRS on ECG. 9 Furthermore, non-dipper hypertensive patients have higher frequency of fQRS on ECG compared to dippers, thus indicating myocardial fibrosis and higher fibrotic burden in non-dippers. 10 , 11 However, the importance and usefulness of fQRS in prehypertensive patients is not clear.…”

Performance ANd ACcuracy in Electrical BioActivity Recordings (PANACEA): A high-performance, wireless, multi-instrument for potentiometric and amperometric recording of biosignals

“…ECG is a crucial diagnostic modality, which examines changes in cardiac electrical activity, e.g. rhythm disturbances [33,34]. ECG uses skin surface electrodes, which detect the electrical current spread throughout the body, caused by the cardiac activity.…”

A high-performance 8 nV/√Hz 8-channel wearable and wireless system for real-time monitoring of bioelectrical signals

“…In addition, electrocardiography examines changes in cardiac electrical activity, e.g. rhythm disturbances, and is thus considered to be a crucial diagnostic modality [23, 24]. Finally, pulmonary veins (PV) play a major role in triggering atrial fibrillation (AF) in humans but the mechanisms underlying PV ectopy remain unclear [25].…”