Volume 3, Issue 3, September 2019, Page: 71-79
Fragmented QRS Complex as a Predictor of High Risk in Acute Coronary Syndrome
Hanan Ibrahim Radwan, Cardiology Department, Zagazig University, Zagazig, Egypt
Kamal Saad Mansour, Cardiology Department, Zagazig University, Zagazig, Egypt
Mohammed Mustafa Al-Daydamony, Cardiology Department, Zagazig University, Zagazig, Egypt
Reema Saed Mohammed, Cardiology Department, Al-Margab University, Alkhoms, Libya
Received: Aug. 17, 2019;       Accepted: Sep. 4, 2019;       Published: Sep. 23, 2019
DOI: 10.11648/j.ccr.20190303.16      View  30      Downloads  7
Abstract
Background: To detect the potential in hospital prognostic value of fQRS complex in patients with acute coronary syndrome (ACS) & investigate whether FQRS complex can be used to distinguish patients with early NSTEMI from those with unstable angina. Methods: It included 150 patients with acute NSTEMI and unstable angina. All patients were subjected to Grace score calculation, ECG to detect ischemic changes and detect presence or absent of fQRS, transthoracic echo to detect LV ejection fraction and recording in-hospital outcome. Results: Patients with fQRS have significant higher Killip class>2, higher troponin &CKMB levels, higher grace score, increased LVEDD & LVESD and significantly lower LVEF%. LVEF is significantly lower among patients with fQRS than patients with not fQRS in NSTEMI patients while there is no significant difference of LVEF % between both groups in unstable angina patients. There is significant association between fQRS and higher prevalence of NSTEMI and higher incidence of heart failure, arrhythmia and bad outcome. By multivariate analysis, NSTEMI (p =0.003) and high HR (p =0.004) and fragmented QRS (p =0.00) were the only significant predictors for bad outcome. FQRS have the ability to diagnose NSTEMI in 47.9% of cases, fQRs can truly exclude NSTEMI in 72.7% of case. Conclusion: Among patients with ACS, the presence of fQRS was associated with an increase incidence of complication, worse outcome, larger LV dimensions, and lower LVEF. The presence of fQRS in acute coronary syndrome patients could predict the presence of NSTEMI with fair diagnostic value.
Keywords
ACS (NSTEMI, Unstable Angina), Fragmented QRS Complex, Hospital Outcome
To cite this article
Hanan Ibrahim Radwan, Kamal Saad Mansour, Mohammed Mustafa Al-Daydamony, Reema Saed Mohammed, Fragmented QRS Complex as a Predictor of High Risk in Acute Coronary Syndrome, Cardiology and Cardiovascular Research. Vol. 3, No. 3, 2019, pp. 71-79. doi: 10.11648/j.ccr.20190303.16
Copyright
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reference
[1]
Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, Chavey WE 2nd, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Smith SC Jr. 2011 ACCF/AHA Focused Update Incorporated Intothe ACC/AHA 2007 Guidelines forthe Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association TaskForce on Practice Guidelines. Circulation. 2011; 123 (18): e426-579. doi: 10.1161/CIR.0b013e318212bb8b. Epub 2011 Mar 28.
[2]
Chatterjee S, Changawala N. Fragmented QRS complex: a novel marker of cardiovascular disease. Clin Cardiol 2010; 33: 68-71.
[3]
Yan GH, Wang M, Yiu KH, Lau CP, Zhi G, Lee SW, Siu CW, Tse HF. Subclinical left ventricular dysfunction revealed by circumferential 2D strain imaging in patientswith coronary artery disease and fragmented QRS complex. Heart Rhythm. 2012 Jun; 9 (6): 928-35. doi: 10.1016/j.hrthm.2012.01.007. Epub 2012 Jan 11.
[4]
Das MK, Suradi H, Maskoun W, Michael MA, Shen C, Peng J, Dandamudi G, Mahenthiran J. Fragmented wide QRS on a 12-lead ECG: a sign of myocardial scar and poor prognosis. Circ Arrhythm Electrophysiol 2008; 1: 258-268.
[5]
Korhonen P, Husa T, Konttila T, Tierala I, Mäkijärvi M, Väänänen H, Ojanen J, Vehtari A, Toivonen L. Fragmented QRS in prediction of cardiac deaths and heart failure hospitalizations aftermyocardial infarction. Ann Noninvasive Electrocardiol. 2010 Apr; 15 (2): 130-7. doi: 10.1111/j.1542-474X.2010.00353.x.
[6]
Akgul O , Uyarel H, Pusuroglu H, Surgit O, Turen S, Erturk M, Ayhan E, Bulut U, Baycan OF, Demir AR, Uslu N. Predictive value of a fragmented QRS complex in patients undergoing primary angioplasty for STelevation myocardial infarction. Ann Noninvasive Electrocardiol. 2015 May; 20 (3): 263-72. doi: 10.1111/anec.12179. Epub 2014 Jul 7.
[7]
Xu RY, Zhu XF, Yang Y, Ye P. High-sensitive cardiac troponin T. J Geriatr Cardiol 2013; 10: 102-109.
[8]
Vasile VC, Jaffe AS. High-Sensitivity Cardiac Troponin for the Diagnosis of Patients with Acute Coronary Syndromes. Curr Cardiol Rep 2017; 19: 92.
[9]
Riedlinger D, Möckel M, Müller C, Holert F, Searle J, von Recum J, Slagman A. High-sensitivity cardiac troponin T for diagnosis of NSTEMI in the elderly emergency department patient: a clinical cohort study. Biomarkers 2018; 23: 551-557.
[10]
Das MK, Michael MA, Suradi H, Peng J, Sinha A, Shen C, Mahenthiran J, Kovacs RJ. Usefulness of fragmented QRS on a 12-lead electrocardiogram in acute coronary syndrome for predicting mortality. Am J Cardiol. 2009 Dec 15; 104 (12): 1631-7. doi: 10.1016/j.amjcard.2009.07.046.
[11]
Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD; Executive Group on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the UniversalDefinition of Myocardial Infarction. Fourth Universal Definition of Myocardial Infarction (2018). Circulation. 2018 Nov 13; 138 (20): e618-e651. doi: 10.1161/CIR.0000000000000617.
[12]
Tanriverdi Z, Dursun H, Simsek MA, Unal B, Kozan O, Kaya D. The Predictive Value of Fragmented QRS and QRS Distortion for High-Risk Patients with STEMIand for the Reperfusion Success. Ann Noninvasive Electrocardiol. 2015 Nov; 20 (6): 578-85. doi: 10.1111/anec.12265. Epub 2015 Feb 2.
[13]
Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU (2015). Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. Mar; 16 (3): 233-70. doi: 10.1093/ehjci/jev014.
[14]
Pietrasik G, Zaręba W. QRS fragmentation: diagnostic and prognostic significance. Cardiol J 2012; 19: 114-121.
[15]
Ari H, Cetinkaya S, Ari S, Koca V, Bozat T. The prognostic significance of a fragmented QRS complex after primary percutaneous coronary intervention. Heart Vessels 2012; 27: 20-28.
[16]
Stavileci B, Cimci M, Ikitimur B, Barman HA, Ozcan S, Ataoglu E, Enar R. Significance and usefulness of narrow fragmented QRS complex on 12-lead electrocardiogram in acute ST-segment elevation myocardial infarction for prediction of early mortality and morbidity. Ann Noninvasive Electrocardiol 2014; 19: 338-344.
[17]
Zhang R, Chen S, Zhao Q, Sun M, Yu B, Hou J. Fragmented QRS complex is a prognostic marker of microvascular reperfusion and changes in LV function occur in patients with ST elevation myocardial infarction who underwent primary percutaneous coronary intervention. Exp Ther Med 2017; 13: 3231-3238.
[18]
Al-Daydamony MM, Mustafa TM. The relation between coronary artery disease severity and fragmented QRS complex in patients with left bundle branch block. Egypt Heart J 2017; 69: 119-126.
[19]
Lorgis L, Cochet A, Chevallier O, Angue M, Gudjoncik A, Lalande A, Zeller M, Buffet P, Brunotte F, Cottin Y. Relationship between fragmented QRS and no-reflow, infarct size, and peri-infarct zone assessed using cardiac magnetic resonance in patients with myocardial infarction. Can J Cardiol 2014; 30: 204-210.
[20]
Carey MG, Luisi AJ Jr, Baldwa S, Al-Zaiti S, Veneziano MJ, deKemp RA, Canty JM Jr, Fallavollita JA. The Selvester QRS Score is more accurate than Q waves and fragmented QRS complexes using the Mason-Likar configuration in estimating infarct volume in patients with ischemic cardiomyopathy. J Electrocardiol. 2010; 43: 318-325.
[21]
Chew DS, Wilton SB, Kavanagh K, Vaid HM, Southern DA, Ellis L, Howarth AG, White JA, Exner DV. Fragmented QRS complexes after acute myocardial infarction are independently associated with unfavorable left ventricular remodeling. J Electrocardiol 2018; 51: 607-612.
[22]
Li M, Wang X, Mi SH, Chi Z, Chen Q, Zhao X, Nie SP. Short-term Prognosis of Fragmented QRS Complex in Patients with Non-ST Elevated Acute Myocardial Infarction. Chin Med J 2016; 129: 518-522.
[23]
Umapathy S, Yadav R, Goswami KC, Karthikeyan G, Parakh N, Bahl VK. Prognostic significance of fragmented QRS in patients with ST-elevation myocardial infarction undergoing revascularization. Indian Heart J 2018; 70 (Suppl 3): S126-S132.
[24]
Lu X, Wang W, Zhu L, Wang Y, Sun K, Zou Y, Tian T, Hui R, Wang J, Kang L, Song L. Prognostic Significance of Fragmented QRS in Patients with Hypertrophic Cardiomyopathy. Cardiology 2017; 138: 26-33.
[25]
Igarashi M, Tada H, Yamasaki H, Kuroki K, Ishizu T, Seo Y, Machino T, Murakoshi N, Sekiguchi Y, Noguchi Y, Nogami A, Aonuma K. Fragmented QRS Is a Novel Risk Factor for Ventricular Arrhythmic Events After Receiving Cardiac Resynchronization Therapy in Nonischemic Cardiomyopathy. J Cardiovasc Electrophysiol 2017; 28: 327-335.
[26]
Attachaipanich T, Krittayaphong R. Fragmented QRS as a predictor of in-hospital life-threatening arrhythmic complications in ST-elevation myocardial infarction patients. Ann Noninvasive Electrocardiol 2019; 24: e12593.
[27]
Kanitsoraphan C, Rattanawong P, Mekraksakit P, Chongsathidkiet P, Riangwiwat T, Kanjanahattakij N, Vutthikraivit W, Klomjit S, Thavaraputta S. Baseline fragmented QRS is associated with increased all-cause mortality in heart failure with reduced ejection fraction: A systematic review and meta-analysis. Ann Noninvasive Electrocardiol 2019; 24: e12597.
[28]
Puelacher C, Gugala M, Adamson PD, Shah A, Chapman AR, Anand A, Sabti Z, Boeddinghaus J, Nestelberger T, Twerenbold R, Wildi K, Badertscher P, Rubini Gimenez M, Shrestha S, Sazgary L, Mueller D, Schumacher L, Kozhuharov N, Flores D, du Fay de Lavallaz J, Miro O, Martín-Sánchez FJ, Morawiec B, Fahrni G, Osswald S, Reichlin T, Mills NL, Mueller C. Incidence and outcomes of unstable angina compared with non-ST-elevation myocardial infarction. Heart. 2019 Apr 24. doi: 10.1136/heartjnl-2018-314305.
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