Short-term Prognosis of Fragmented QRS Complex in Patients with Non-ST Elevated Acute Myocardial Infarction

Background：There remains significant debate as to the relationship between fragmented QRS （fQRS） complexes on electrocardiogram （ECG） and acute myocardial infarction （AMI）.Few studies have reported on this relationship in non-ST elevated AMI （NSTEMI）,and thus,we attempt to assess this relationship and its potential short-term prognostic value.Methods：This was a single-center,observational,retrospective cohort study.A total of 513 consecutive patients （399 men,114 women） with NSTEMI within 24 h who underwent coronary angiography at our department,between January 1,2014,and December 31,2014.Patients were divided into 2 groups according to the presence or absence of fQRS complex on the admission ECG.fQRS complexes were defined as the existence of an additional R＇ or crochetage wave,notching in the nadir of the S wave,RS fragmentation,or QS complexes on 2 contiguous leads.All patients were followed up for 6 months,and all major adverse cardiac events （MACE） were recorded.Results：In this study,there were 285 patients with fQRS ECG in the 513 patients with NSTEMI.The number of patients with 0-2 coronary arteries narrowed by ≥50% in fQRS group were less while patients with 3 narrowed arteries were more than in the non-fQRS group （P =0.042）.There were fewer Killip Class Ⅰ patients in the fQRS group （P =0.019）,while Killip Class Ⅱ,Ⅲ,and Ⅳ patients were more in the fQRS group than in the non-fQRS group （P =0.019）.Left ventricular ejection fraction levels were significantly lower in the fQRS group （P =0.021）.Baseline total cholesterol,low-density lipoprotein,creatinine,creatine kinase,homocysteine,high-sensitivity C-reactive protein （CRP）,and red blood cells distribution width levels were significantly higher in the fQRS group.Total MACE （MACE,P =0.028）,revascularization （P =0.005）,and recurrent angina （P =0.005） were also significantly greater in the fQRS group.On final logistic regression analysis,after adjusting for baseline variables,the following variables were independent predictors of fQRS：Coronary artery narrowing （P =0.035）,Killip classification （P =0.026）,and total cholesterol （P =0.002）.The following variables were found to be independent predictors of preoperative MACE：Hemoglobin （P =0.000）,gender （P =0.026）,fQRS （P =0.016）,and time from myocardial infarction to balloon or coronary artery bypasses grafting （P =0.013）.Conclusions：The fQRS complexes are commonly present in NSTEMI and the fQRS complexes are an independent predictor of MACE in NSTEMI patients.The number of narrowed coronary arteries,Killip classification,and total cholesterol are all independent predictors of the fQRS complexes.

Presence of Fragmented QRS Complexes in Patients with Obstructive Sleep Apnea Syndrome

Background：Obstructive sleep apnea syndrome （OSAS） is a disease with increasing prevalence,which is mainly characterized by increased cardiopulmonary mortality and morbidity.It is well-known that OSAS patients have increased prevalence of cardiovascular diseases including coronary heart disease,heart failure,and arrhythmias.The aim of this study was to evaluate the presence of prolonged and fragmented QRS complexes,which have previously been associated with cardiovascular mortality,in OSAS patients.Methods：Our study included 51 patients （mean age 41.6 ± 10.1 years） who were recently diagnosed with OSAS （apnea-hypopnea index [AHI] ≥5 events/h） and never received therapy.The control group consisted of 34 volunteers （mean age 43.1 ± 11.6 years） in whom OSAS was excluded （AHI 〈5 events/h）.The longest QRS complexes was measured in the 12-lead electrocardiogram （ECG） and the presence of fragmentation in QRS complexes was investigated.Results：Fragmented QRS frequency was significantly higher in patients with OSAS （n =31 [61%] vs.n =12 [35%],P =0.021）.QRS and QTc durations were also significantly longer in OSAS patients than controls （99.8 ± 13.9 ms vs.84.7 ± 14.3 ms,P 〈 0.001;411.4 ± 26.9 ms vs.390.1 ± 32.2 ms,P =0.001,respectively）.Analysis of the patient and controls groups combined revealed a weak-moderate correlation between AHI and QRS duration （r =0.292,P =0.070）.OSAS group had no correlation between AHI and QRS duration （r =-0.231,P =0.203）.Conclusions：In our study fragmented QRS frequency and QRS duration were found to increase in OSAS patients.Both parameters are related with increased cardiovascular mortality.Considering the prognostic importance of ECG parameters,it may be reasonable to recommend more detailed evaluation of OSAS patients with fragmented or prolonged QRS complexes with respect to presence of cardiovascular diseases.

Efficacy of cardiac resynchronized therapy on patients with a fragmented QRS complex

Background Based on previous studies, a fragmented QRS （fQRS） complex, as a predictive biomarker of myocardial scarring condition, could be used to predict the outcomes of cardiac resynchronized therapy （CRT）. However, this conclusion is still debatable. Methods Fifty ischemic or non-ischemic cardiomyopathy patients failure （aged 65 ± 10 yrs, 34 males, 16 females） with refractory heart, diagnosed by the criteria of New York Heart Association received CRT. The ECGs of 18 patients with a fQRS complex （divided by Das） were compared with those of 32 patients without a fQRS complex, who were evaluated by 12-lead ECG before CRT. The patients were followed up for six months, and 12-lead ECG and echocardiography were reviewed. At least 15% reduction in the left ventricular end-systolic volume （LVESV） was defined as responders according to the data obtained for between-group and intra-group analysis. Results Six patients （33.3%） in the fQRS group and 24 patients （75%） in the non-fQRS group responded well. In addition, comparisons of indicators from surface ECG and echocardiography 6 months after CRT showed that the non-fQRS group benefited from CRT significantly more than the fQRS group. Conclusions The fQRS complex has good predictive value for responsiveness to CRT. Non-fQRS complex patients with refractory heart failure may benefit more from CRT, and these patients need to receive this treatment as early as possible.

Validity of QRS Configuration and Myeloperoxidase Level as Determinants of CAD Severity and Prognosis in Patients with STEMI

Background: Terminal QRS distortion and fragmentation (fQRS) with elevated myeloperoxidase (MPO) were linked to poor cardiovascular outcomes in acute coronary syndrome. We aimed to investigate these parameters in early prediction of coronary artery disease severity based on SYNTAX score and in-hospital adverse events in STEMI patients. Methods: A total of 215 patients with first STEMI admitted for primary PCI were included in the study. They were divided according to the admission ECG into group I with QRS distortion or fQRS, group II with combined QRS distortion and fQRS, and group III without QRS distortion or fQRS. Myeloperoxidase and troponin I levels, ST resolution ratio, left ventricular EF%, and severity of coronary artery lesions using SYNTAX risk score were measured. Results: MPO level, SYNTAX score, and in-hospital mortality were higher in group I and II and were higher in group II compared to group I. By regression analysis, QRS distortion, fQRS, and MPO > 412 ng/ml were independent predictors of both CAD severity and in-hospital mortality. DM was an independent predictor of CAD severity (OR: 2.851, P 0.012) while high SYNTAX score was an independent predictor of in-hospital mortality (OR: 6.113, P 0.001). Adding MPO level to any QRS configuration pattern increased predictive value for the detection of CAD severity that was more evident in the combined QRS distortion and fragmentation. Conclusion: Terminal QRS distortion, fragmentation, or combined QRS distortion and fragmentation have a significant value in predicting in-hospital adverse events and CAD severity as assessed by SYNTAX score in association with plasma myeloperoxidase level in STEMI patients. Combined QRS distortion and fragmentation, in spite less common, could be more helpful for early risk stratification and management.

Electrocardiographic alterations in patients with chronic obstructive pulmonary disease

Patients with chronic obstructive pulmonary disease(COPD)have an increased risk for cardiovascular events,and electrocardiography has an important role in detecting cardiac side effects of COPD-related hypoxia.