Fragmented QRS Complexes Are Associated with Increased Left Ventricular Mass in Patients with Essential Hypertension (original) (raw)
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Journal of Electrocardiology, 2007
The aim of this study was to analyze the relationship between QRS amplitude and left ventricular mass (LVM) in hypertensive patients identified by screening, with the focus on those without left ventricular hypertrophy (LVH). M Me et th ho od ds s: : The entire study group consisted of 189 healthy subjects (average 39.6 years) and 54 subjects with hypertension (average 52.4 years). The LVH-free subgroup consisted of 159 normal subjects and 30 hypertensive patients. Electrocardiograms were recorded and the magnitude of the maximum QRS spatial vector magnitude (QRSmax) was calculated from the RaVF, RV5 and SV2 amplitudes. The LVM was estimated echocardiographically. The specific potential of myocardium (SP) was calculated as a ratio of QRSmax to LVM. R Re es su ul lt ts s: : Contrary to higher LVM values in hypertensive subjects (240.2±58.7g and 191.5±48.3 g, respectively), the QRSmax values (1.9±0.5 mV and 2.0±0.6 mV, respectively) and SP values (8.3±2.5*10-3 mV/g and 11.3±4.4*10-3 mV/g, respectively) were significantly lower as compared to healthy subjects in the entire study group. Also in the LVH-free subgroup the SP values were significantly lower in hypertensive patients (8.70±2.83*10-3 mV/g and 10.98±4.79*10-3 mV/g, respectively). The lower values of QRSmax and SP could not be explained by the differences in age and body mass index between the hypertensive patients and normal subjects. C Co on nc cl lu us si io on n: : We showed that the SP provides a more sensitive parameter for the evaluation of early hypertrophic remodeling as compared to separated evaluation of LVM and QRS voltage already in subjects with no signs of cardiac target organ involvement according to current clinical classification.
Journal of Electrocardiology, 2019
Background: Ventricular arrhythmias (VAs) are frequent in hypertensive patients. Myocardial fibrosis is one of the components left ventricular hypertrophy secondary to hypertension. Fragmented QRS (fQRS) on electrocardiography (ECG) has been shown to be a marker of myocardial fibrosis. In this study, we aimed to investigate the association between fQRS and complex VAs in patients with essential hypertension. Methods: Two hundreds consecutive patients who were diagnosed with hypertension were included in the study. The control group consisted of 153 age and sex matched healthy individuals. ECG and transthoracic echocardiography were performed to all patients. fQRS was defined as additional R' wave or notching/splitting of S wave in two contiguous ECG leads. All patients underwent 24-hour Holter monitoring and VAs were classified using Lown's scoring system. Lown class ≥ 3 VAs were considered as complex VAs. Results: There was no significant difference with respect to age (52±8 vs 52±6, p=0.836) and gender distribution (female: 64% vs 63%, p=0.907) between the groups. As compared to the healthy individuals, prevalence of fQRS (67% vs 9.2%, p<0.001) and complex VAs (19% vs 0%, p<0.001) were significantly higher in patients with hypertension. Furthermore, complex VAs (25.4% vs 6.1%, p=0.001) were significantly higher in hypertensive patients with fQRS. In multiple logistic regression analysis, left ventricular ejection fraction (OR: 1.11, 95%CI:1.025 to 1.183; p=0.006), left ventricular mass index (OR: 1.04, 95%CI: 1.021 to 1.107; p=0.001) and presence of fQRS (OR: 5.605, 95%CI: 1.427 to 22.019; p=0.014) were independent predictors for complex VAs. Conclusion: The presence of fQRS may be associated with complex VAs in patients with essential hypertension. Therefore, fQRS may be used in risk stratification of complex VAs and sudden cardiac death especially in hypertensive patients with LVH.
Fragmented QRS Complexes are a Marker of Myocardial Fibrosis in Hypertensive Heart Disease
Turk Kardiyoloji Dernegi Arsivi-Archives of the Turkish Society of Cardiology, 2016
Carboxy-terminal propeptide of type 1 procollagen (PICP) is a marker of extracellular collagen synthesis. Fragmented QRS (fQRS) on a 12-lead electrocardiogram (ECG) has been demonstrated as a marker of myocardial fibrosis. The present objective was to investigate the association between serum PICP concentration and presence of fQRS on ECG in hypertensive patients. Methods: Consecutive patients with previously or newly diagnosed hypertension were included. fQRS was defined as the presence of additional R-wave (R'), or notching of R-or Swaves, or the presence of fragmentation in 2 contiguous ECG leads. Serum PICP levels were measured by ELISA method. Results: The study group consisted of 90 hypertensive patients (74% females, with a mean age of 54.7±8.5 years). Of these patients, 47 (52.2%) had fQRS on ECG. Age (p=0.121) and gender distribution (p=0.625) were similar in patients with or without fQRS. Receiver operating characteristic curve analysis yielded a strong predictive ability of PICP levels for the presence of fQRS (area under the curve: 0.850; 95% CI: 0.772-0.929; p<0.0001). In multivariate logistic regression analysis, PICP levels were strongly and independently associated with the presence of fQRS (OR: 1.938; 95% CI: 1.398-2.688). Conclusion: Serum PICP level is a strong and independent predictor of fQRS. Discriminative performance of serum PICP levels for the presence of fQRS is high. The present results are the first to demonstrate that fQRS may indicate myocardial fibrosis in patients with hypertension.
Usefulness of fragmented QRS in hypertensive patients in the absence of left ventricular hypertrophy
Journal of clinical hypertension (Greenwich, Conn.), 2017
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 (odds ratio, 0.931; 95% CI, 0.910-0.9521 [P<.001]) even after adjusting for other confounding factors. Receiver operating characteristic analysis revealed a cutoff value of 147.65 mm Hg for systolic blood pressure to predict presence of fQRS (sensitivity: 51%, specificity: 99%, area under the curve=0.764; 95% CI, 0.717-0.811 [P<.0...
American Heart Journal, 1998
Left ventricular hypertrophy (LVH) is considered as an independent risk factor for coronary artery disease (CAD) and cardiovascular complications. 1 It has been established that CAD, stroke, and sudden death are more frequent in patients with LVH. 2,3 Variations of the QT interval on the standard electrocardiograph (ECG) have been associated with increased sudden death incidence in a middle-aged population 4 and in patients with CAD. 5,6 An increase in QT dispersion has been considered as predisposing to serious ventricular arrhythmias or sudden death in hypertrophic cardiomyopathy, 7 congestive heart failure or dilated cardiomyopathy, 8 and coronary artery disease, 9 as well as after myocardial infarction. 10 An increased QT dispersion also has been found 11-13 in hypertensive patients with LVH. We assessed the behavior of QT dispersion after LVH regression. Previous data on this subject are limited. 12 Methods We retrospectively studied 68 patients (42 men and 26 women, mean age 56.3 ± 9.5 years) with hypertension. All enrolled patients were without medication for at least 1 month before entrance in the study. To qualify for enrollment, sitting diastolic blood pressure (average of 3 readings) had to be measured from 95 to 110 mm Hg at rest. All were included in the study after a detailed clinical and laboratory examination for exclusion of serum electrolyte abnormalities. Patients with manifestations of CAD, arrhythmias, congestive heart failure, valvular heart disease, diabetes mellitus, renal
Journal of Clinical Ultrasound, 2019
Background: Epicardial adipose tissue (EAT) is a cardiometabolic risk factor, and its possible relationship with hypertension has been reported previously. Fragmented QRS (fQRS) detected on electrocardiography (ECG) has been demonstrated to be a marker of myocardial fibrosis. In this study, we aimed to investigate the relationship between the thickness of EAT, and presence of fQRS in hypertensive patients. Methods: Consecutive patients who were diagnosed with hypertension were included in the study. ECG and transthoracic echocardiography (TTE) were performed to all patients. fQRS was defined as additional R 0 wave or notching/splitting of S wave in two contiguous ECG leads. Thickness of EAT was measured by TTE. Results: This study enrolled 69 hypertensive patients with fQRS on ECG and 45 hypertensive patients without fQRS as the control group. Age (P = .869), and gender distribution (P = .751) were similar in both groups. Left atrial diameter (P = .012), interventricular septal thickness (P < .001), posterior wall thickness (P < .001), left ventricular ejection fraction (P = .009), left ventricular mass (P = .006), left ventricular mass ındex (P = .014), left ventricular hypertrophy (P = .003), and EAT thickness (P < .001) were found to be significantly increased in patients with fQRS. In multivariate analysis, among these variables only EAT was observed to be an independent predictor of fQRS (odds ratio:3.306 [95% confidence interval, 0.030-0.118], P = .001). Conclusion: A significant association exists between the presence of fQRS and EAT thickness in hypertensive patients. The presence of fQRS, just as EAT thickness, may be used as a cardiometabolic risk factor in hypertensive patients.
Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2015
Diastolic dysfunction occurs as a result of interstitial fibrosis in hypertensive patients. Fragmented QRS (fQRS) on ECG signifies myocardial fibrosis in various clinical situations. We investigated whether fQRS on ECG is related to diastolic dysfunction in patients with hypertension. The study population included 72 hypertensive patients with normal coronary angiogram. Fragmented QRS was defined as the presence of an additional R wave (R'), notching of the R or S wave or fragmentation in two contiguous leads corresponding to a major coronary artery. Echocardiography was performed to all patients to detect diastolic dysfunction. Diastolic dysfunction was regarded as non-severe if patients had normal diastolic function or grade 1 diastolic dysfunction or severe if they had grade ≥2 diastolic dysfunction. Thirty-two patients had fQRS on ECGs (fQRS [+] group) and there were 40 patients who did not have fQRS on their ECGs (fQRS [-] group). The two groups were similar in terms of bas...
2010
This study was designed to assess the relation of electrocardiographic (ECG) strain to increased left ventricular (LV) mass, independent of its relation to coronary heart disease (CHD). BACKGROUND The classic ECG strain pattern, ST depression and T-wave inversion, is a marker for left ventricular hypertrophy (LVH) and adverse prognosis. However, the independence of the relation of strain to increased LV mass from its relation to CHD has not been extensively examined. METHODS Electrocardiograms and echocardiograms were examined at study baseline in 886 hypertensive patients with ECG LVH by Cornell voltage-duration product and/or Sokolow-Lyon voltage enrolled in the Losartan Intervention For End point (LIFE) echocardiographic substudy. Strain was defined as a downsloping convex ST segment with inverted asymmetrical T-wave opposite to the QRS axis in leads V 5 and/or V 6. RESULTS Strain occurred in 15% of patients, more commonly in patients with than without evident CHD (29%, 51/175 vs. 11%, 81/711, p Ͻ 0.001). When differences in gender, race, diabetes, systolic pressure, serum creatinine and high density lipoprotein cholesterol were controlled, strain on baseline ECG was associated with greater indexed LV mass in patients with (152 Ϯ 33 vs. 131 Ϯ 32 g/m 2 , p Ͻ 0.001) or without CHD (131 Ϯ 24 vs. 119 Ϯ 22 g/m 2 , p Ͻ 0.001). In logistic regression analyses, strain was associated with an increased risk of anatomic LVH in patients with CHD (relative risk 5.14, 95% confidence interval [CI] 1.16 to 22.85, p ϭ 0.0315), without evident CHD (relative risk 2.91, 95% CI 1.50 to 5.65, p ϭ 0.0016), and in the overall population when CHD was taken into account (relative risk 2.98, 95% CI 1.65 to 5.38, p ϭ 0.0003). CONCLUSIONS When clinical evidence of CHD is accounted for, ECG strain is likely to indicate the presence of anatomic LVH. Greater LV mass and higher prevalence of LVH in patients with strain offer insights into the known association of the strain pattern with adverse outcomes.