Clinical Implications of Fragmented QRS Complex as an Outcome Predictor in Children with Idiopathic Dilated Cardiomyopat
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ORIGINAL ARTICLE
Clinical Implications of Fragmented QRS Complex as an Outcome Predictor in Children with Idiopathic Dilated Cardiomyopathy Younghwa Kong1 · Jinyoung Song2 · I‑Seok Kang2 · June Huh2,3 Received: 24 May 2020 / Accepted: 24 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Fragmented QRS (fQRS) is an easily evaluated noninvasive parameter in electrocardiograms (ECGs) for predicting cardiac adverse events. Our study aimed to evaluate whether fQRS could be used as a risk factor to predict a major adverse cardiac event (MACE) in children with idiopathic dilated cardiomyopathy (DCM). Our retrospective study enrolled 63 patients aged ≤ 19 years who were newly diagnosed with idiopathic DCM at Samsung Medical Center from 2003 to 2014, and followed up until December 2018. Demographic data, ECGs, and echocardiography were reviewed and analyzed for their possible links with adverse outcomes. The median age was 14.0 months and the median length of follow-up was 65.0 months. Age, QRS duration, and ejection fraction in M-mode at diagnosis were significantly different between the fQRS and nonfQRS groups (P = 0.026; P = 0.001; and P = 0.020). Significant difference between the fQRS and non-fQRS groups was found in patients with a MACE (P = 0.016, odd ratio 3.643) or any arrhythmias (P = 0.008, odd ratio 6.563). The MACE-free survival rate showed a significant difference in terms of fQRS (P = 0.003; P = 0.007; and P = 0.027). In univariate analyses, age, QRS duration, corrected QT, positive fQRS, and the number of leads with fQRS were significant predictors of MACEs. Among the above factors, positive fQRS at diagnosis was a strongly significant predictor of adverse outcomes in multivariate analyses (hazards ratio 94.529, P = 0.001). Fragmented QRS complex at diagnosis could be used as a strong predictor for cardiac adverse outcomes in pediatric patients with idiopathic DCM. Keywords Dilated cardiomyopathy · Fragmented QRS · Pediatrics · Adverse outcome
Introduction In electrocardiograms (ECGs), T wave inversion, QRS duration, and the QRS/T angle at rest are easily evaluated parameters. Previous studies have shown that these factors are related to morbidity and mortality in patients with coronary artery disease or in the general population [1–3]. A * June Huh [email protected]; [email protected] 1
Department of Pediatrics, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
2
Department of Pediatrics, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
3
Department of Pediatrics, Grown‑Up Congenital Heart Clinic, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon‑ro, Gangnam‑gu, Seoul 06351, Korea
fragmented QRS complex (fQRS) is a noninvasive ECG parameter. The presence of fQRS has been associated with alter
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