Value of Fragmented QRS Complex on 12-lead ECG as A Valuable Marker of Myocardial Damage of CAD Patients (original) (raw)
Related papers
Fragmented wide QRS on a 12-lead ECG: a sign of myocardial scar and poor prognosis
Circulation: …, 2008
Background-Fragmented QRS (duration Ͻ120 ms) on a 12-lead ECG represents myocardial scar in patients with coronary artery disease. However, the significance of fragmented QRS has not been defined in the presence of a wide QRS (wQRS; duration Ն120 ms). We postulate that fragmented wQRS (f-wQRS) due to bundle branch block, premature ventricular complexes, or paced rhythms (f-pQRS) signify myocardial scar and higher mortality. Methods and Results-Patients who underwent cardiac evaluation with nuclear stress imaging or cardiac catheterization and had wQRS (bundle branch block, premature ventricular complex, or pQRS) were studied. f-wQRS was defined by the presence of Ͼ2 notches on the R wave or the S wave and had to be present in Ն2 contiguous inferior (II, III, aVF), lateral (I, aVL, V 6) or anterior (V 1 to V 5) leads. ECG analyses of 879 patients (age, 66.7Ϯ11.4 years; male, 97%; mean follow-up, 29Ϯ18 months) with bundle branch block (nϭ310), premature ventricular complex (nϭ301), and pQRS (nϭ268) revealed f-wQRS in 415 (47.2%) patients. Myocardial scar was present in 440 (50%) patients. The sensitivity, specificity, positive predictive value, and negative predictive value of f-wQRS for myocardial scar were 86.8%, 92.5%, 92.0%, and 87.5%, respectively. The sensitivity and specificity for diagnosing myocardial scar were 88.6% and 94.4%, 81.4% and 88.4%, and 89.8% and 95.7% for f-bundle branch block, f-premature ventricular complex, and f-pQRS, respectively. f-wQRS was associated with mortality after adjusting for age, ejection fraction, and diabetes (Pϭ0.017). Conclusions-f-wQRS on a standard 12-lead ECG is a moderately sensitive and highly specific sign for myocardial scar in patients with known or suspected coronary artery disease. f-wQRS is also an independent predictor of mortality. (Circ
Significance of a Fragmented QRS Complex Versus a Q Wave in Patients With Coronary Artery Disease
2010
Background-Q waves on a 12-lead ECG are markers of a prior myocardial infarction (MI). However, they may regress or even disappear over time, and there is no specific ECG sign of a non-Q-wave MI. Fragmented QRS complexes (fQRSs), which include various RSRЈ patterns, without a typical bundle-branch block are markers of altered ventricular depolarization owing to a prior myocardial scar. We postulated that the presence of an fQRS might improve the ability to detect a prior MI compared with Q waves alone by ECG. Methods and Results-A cohort of 479 consecutive patients (meanϮSD age, 58.2Ϯ13.2 years; 283 males) who were referred for nuclear stress tests was studied. The fQRS included various morphologies of the QRS (Ͻ120 ms), which included an additional R wave (RЈ) or notching in the nadir of the S wave, or Ͼ1 RЈ (fragmentation) in 2 contiguous leads, corresponding to a major coronary artery territory. The Q wave was present in 71 (14.8%) patients, an fQRS was present in 191 (34.9%) patients, and an fQRS and/or a Q wave was present in 203 (42.3%) patients. Sensitivity, specificity, and the negative predictive value for myocardial scar as detected by single photon emission computed tomography analysis were 36.3%, 99.2%, and 70.8%, respectively, for the Q wave alone; 85.6%, 89%, and 92.7%, respectively, for the fQRS; and 91.4%, 89%, and 94.2%, respectively, for the Q wave and/or fQRS. Conclusions-The fQRS on a 12-lead ECG is a marker of a prior MI, defined by regional perfusion abnormalities, which has a substantially higher sensitivity and negative predictive value compared with the Q wave. (Circulation. 2006;113: 2495-2501.)
Kardiologia polska, 2015
Accurate diagnosis of Myocardial infarction (MI) is of paramount importance in patient management which necessitates the development of efficient as well as accurate diagnostic methods. Q wave is not present in all patients with MI and its prevalence is declining. Recently, fragmented QRS (Fqrs) complex has been introduced as a marker of prior MI. In this study, we intended to investigate diagnostic value of fQRS compared to Q wave. We included 500 consecutive patients with known or suspected Coronary Artery Disease (CAD) who underwent two days gated myocardial perfusion imaging (MPI) using Dipyridamole pharmacologic stress. ECG was evaluated to detect fQRS as well as Q-Wave. Finally, subjects were compared in terms of ventricular perfusion and function indices. 207 men and 269 women with mean age of 57.06±12 years were studied. ECG analysis showed that 14.3% of the patients had both fQRS and Q waves, 30.7% had fQRS and 3.8% had Q waves. Fixed myocardial perfusion defect was noted i...
The American Journal of Cardiology, 2009
Electrocardiographic signs of a non-ST elevation myocardial infarction (NSTEMI) are nonspecific, and therefore the diagnosis of NSTEMI during acute coronary syndromes (ACS) depends mainly on cardiac biomarker levels. Fragmented QRS (fQRS) represents myocardial conduction abnormalities due to myocardial infarction (MI) scars in patients with coronary artery disease. However, the time of appearance of fQRS during ACS has not been investigated. It was postulated that in patients with ACS, fQRS on 12-lead electrocardiography occurs within 48 hours of presentation with NSTEMI as well as ST elevation MI and that fQRS predicts mortality. Serial electrocardiograms from 896 patients with ACS (mean age 62 ؎ 11 years, 98% men) who underwent cardiac catheterization were studied. Four hundred forty-one patients had MIs, including 337 patients with NSTEMIs, and 455 patients had unstable angina (the control group). Serial electrocardiograms were obtained every 6 to 8 hours during the first 24 hours after the diagnosis of MI and the next day (<48 hours). Fragmented QRS on 12-lead electrocardiography was defined by the presence of single or multiple notches in the R or S wave, without a typical bundle branch block, in >2 contiguous leads in 1 of the major coronary artery territories. Fragmented QRS developed in 224 patients (51%) in the MI group and only 17 (3.7%) in the control group (p <0.001). New Q waves developed in 122 (28%), 76 (23%), and 2 (0.4%) patients in the MI, NSTEMI, and control groups, respectively. The sensitivity values of fQRS for ST elevation MI and NSTEMI were 55% and 50%, respectively. The specificity of fQRS was 96%. Kaplan-Meier survival analysis revealed that patients with fQRS had significantly decreased times to death compared to those without fQRS. Fragmented QRS, T-wave inversion, and ST depression were independent predictors of mortality during a mean follow-up period of 34 ؎ 16 months. In conclusion, fQRS on 12-lead electrocardiography is a moderately sensitive but highly specific sign for ST elevation MI and NSTEMI. Fragmented QRS is an independent predictor of mortality in patients with ACS. Published by Elsevier
The Predictive Value of Fragmented QRS Complex in Diagnosis of Myocardial Ischemia
Benha Medical Journal, 2024
Background: Fragmented QRS (fQRS) on the ECG is a straightforward, affordable, and widely accessible indicator of myocardial fibrosis and scarring. Aim: This study aimed to assess the predictive value of (fQRS) in diagnosing myocardial ischemia. It evaluated its incremental prognostic significance in patients having single-photon emission computed tomography (SPECT) for exercise-induced myocardial ischemia. Methods: This observational case-control research was executed on 206 patients who underwent exercise myocardial perfusion SPECT for suspected stable chronic CAD. All patients were subjected to demographic, clinical, and laboratory data, electrocardiography, echocardiography, and SPECT myocardial perfusion imaging. The existence of fQRS was determined based on electrocardiographic criteria. Multivariate logistic regression analysis was applied to predict myocardial ischemia, and the incremental prognostic value of fQRS was determined utilizing hierarchical regression analysis. Results: The patients had a mean age of 53 ±10 years, and more than one-quarter (28.2%) had fQRS. Patients with myocardial ischemia (Group I) had a greater prevalence of fQRS than the control group fQRS (42.3% vs. 23.4%, P = 0.009). In multivariate analysis, fQRS significantly predicted myocardial ischemia (OR = 2.298, 95% CI = 1.102-4.792, P = 0.026). Furthermore, compared to traditional risk factors and a combination of conventional risk factors and STT alterations, the fQRS demonstrated an added predictive value (Global X 2 = 34.612). Conclusions: Fragmented QRS complex is a promising ECG marker significantly associated with myocardial ischemia. Its inclusion in risk assessment models enhances predictive accuracy, aiding early CAD diagnosis and risk stratification in patients with stable chronic coronary artery disease
Fragmented QRS Complexes—A Novel but Underutilized Electrocardiograhic Marker of Heart Disease
Critical pathways in cardiology, 2013
the electrocardiogram is the mainstay approach for diagnosing a myocardial infarction (Mi). the diagnosis of an old Mi and the identification of myocardial scar via the electrocardiogram are difficult because there are no other specific signs for a non-Q-wave Mi. in this article, we will review the fragmented QRS and its role in identifying myocardial scar and depolarization abnormalities in patients with coronary artery disease.
The Anatolian Journal of Cardiology, 2015
Objective: Fragmented QRS (fQRS) complexes that have numerous RSR´ patterns represent alteration of ventricular depolarization. We evaluated the relationship between fQRS and poor coronary collateral circulation and the diagnostic ability of fQRS for myocardial scar detection in patients with chronic total occlusion (CTO) without a history of myocardial infarction. Methods: The study population consisted of patients undergoing coronary angiography with a suspicion of CAD. Seventy-nine patients with one totally occluded major coronary artery were enrolled. Exclusion criteria were history of MI; recent acute coronary syndrome; pathologic Q wave on 12-lead ECG; cardiomyopathy or severe valvular disease; coronary artery bypass surgery or percutaneous coronary angioplasty. Collateral circulation was scored on the basis of Rentrop's classification. All patients were assessed by myocardial perfusion SPECT. Fragmented QRS was characterized as existence of an R´ or R wave or S wave notch in two adjacent leads related to the location of a major coronary artery region. Single and multiple logistic regression analyses were completed in the forward method. Results: Forty-nine patients had poor and 30 had well-developed collateral circulation. Fragmented QRS complexes were significantly higher in the poor collateral group (81% vs. 20%, p<0.001). Sensitivity, specificity, and the positive and negative predictive values of fQRS for myocardial scar identification were 89.4%, 87.5%, and 91.3% and 84.8%, respectively. The summed stress score and the summed rest score on SPECT were significantly higher in the poor collateral group than in the well-developed group (p<0.001) as well as in the fQRS group than the non-fQRS group (p<0.001). Logistic regression analysis revealed that the presence of fQRS was significantly and independently associated with poor collateral circulation and myocardial scar in patients with CTO. Conclusion: Fragmented QRS is independently related to poor coronary collateral circulation in patients with CTO without prior myocardial infarction. Notably, it can be a good predictor of myocardial scar rather than merely ischemia, with high diagnostic accuracy.
Journal of Cardiovascular Magnetic Resonance, 2009
Introduction: Prophylactic implantation of a cardioverter/ defibrillator (ICD) has been shown to reduce mortality in patients with chronic myocardial infarction (CMI) and an increased risk for life threatening ventricular arrhythmia (VA). The use of ICDs in this large patient population is still limited by high costs and possible adverse events including inappropriate discharges and progression of heart failure. VA is related to infarct size and seems to be related to infarct morphology. Contrast enhanced cardiovascular magnetic resonance imaging (ceCMR) can detect and quantify myocardial fibrosis in the setting of CMI and might therefore be a valuable tool for a more accurate risk stratification in this setting. Hypothesis: ceCMR can identify the subgroup developing VA in patients with prophylactic ICD implantation following MADIT criteria. Methods: We prospectively enrolled 52 patients (49 males, age 69 ± 10 years) with CMI and clinical indication for ICD therapy following MADIT criteria. Prior to implantation (36 ± 78 days) patients were investigated on a 1.5 T clinical scanner (Siemens Avanto © , Germany) to assess left ventricular function (LVEF), LV end-diastolic volume (LVEDV) and LV mass (sequence parameters: GRE SSFP, matrix 256 × 192, short axis stack; full LV coverage, no gap; slice thickness 6 mm). For quantitative assessment of infarct morphology late gadolinium enhancement (LGE) was performed including measurement of total and relative infarct mass (related to LV mass) and the degree of transmurality (DT) as defined by the percentage of transmurality in each scar. (sequence parameters: inversion recovery gradient echo; matrix 256 × 148, imaging 10 min after 0.2 μg/kg gadolinium DTPA; slice orientation equal to SSFP). MRI images were analysed using dedicated software (MASS © , Medis, Netherlands). LGE was defined as myocardial areas with signal intensity above the average plus 5 SD of the remote myocardium. After implantation, patients were followed up including ICD readout after 3 and than every 6 months for a mean of 945 ± 344 days. ICD data were evaluated by an experienced electrophysiologist. Primary endpoint was the occurrence of an appropriate discharge (DC), antitachycard pacing (ATP) or death from cardiac cause. Results: The endpoint occurred in 10 patients (3 DC, 6 ATP, 1 death). These patients had a higher relative infarct mass (28 ± 7% vs. 22 ± 11%, p = 0.03) as well as high degree of transmurality (64 ± 22% vs. 44 ± 25%, p = 0.05). Their LVEF (29 ± 8% vs. 30 ± 4%, p = 0.75), LV mass (148 ± 29 g vs. 154 ± 42 g, p = 0.60), LVEDV (270 ± 133 ml vs. 275 ± 83 ml, p = 0.90) or total infarct mass (43 ± 19 g vs. 37 ± 21 g, p = 0.43) were however not significant from the group with no events. In a cox proportional hazards regression model including LVEF, LVEDV, LV mass, DT and age, only degree of transmurality and relative infarct mass emerged as independent predictors of the primary end point (p = 0.009). Conclusion: In CMI-patients fulfilling MADIT criteria ceCMR could show that the extent and transmurality of myocardial scarring are independent predictors for life threatening ventricular arrhythmia or death. This additional information could lead to more precise risk stratification and might reduce adverse events and cost of ICD therapy in this patient population. Larger trials are needed to confirm this finding.