Relationship between fragmented QRS complexes and left ventricular systolic and diastolic functions
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a1 · S.A. Kocaman1 · M.E. Durakoğlugil2 · M. Çetin1 · T. Erdoğan2 · T. Kırış3 · M. Erden4 1 Department of Cardiology, Rize Education and Research Hospital, Rize 2 Department of Cardiology, Rize University Medical Faculty, Rize 3 Department of Cardiology, Ordu State Hospital, Ordu 4 Department of Cardiology, Private Medikar Hospital, Karabuk
Relationship between fragmented QRS complexes and left ventricular systolic and diastolic functions QRS complex fragmentations are frequently seen on routine surface electrocardiograms (ECG) with a narrow or wide QRS complex and include paced rhythm, bundle branch block, or ventricular premature beats [1]. These fragmentations on surface ECG were found to be associated with increased adverse cardiac events in previous studies [2, 3, 4, 5]. Fragmented QRS complexes (fQRS) on a 12-lead resting ECG are defined as various RSR’ patterns with or without Q waves without a typical bundle branch block in two contiguous leads corresponding to a major coronary artery territory [6]. fQRS might often be the only electrocardiographic marker of myocardial damage in patients with non-Q myocardial infarction and in patients with resolved Q wave [6]. Previous studies focused on the association between fQRS and increased morbidity and mortality, sudden cardiac death, and recurrent adverse cardiac events [4, 5, 7, 8, 9, 10]. In these studies, cardiac fibrosis was shown to be the main causative mechanism [11, 12]. Additionally, fQRS may represent altered ventricular depolarization, caused by nonhomogeneous activation of ischemic ventricles. The association between left ventricular systolic and diastolic functions and the presence of fragmented QRS has not been comprehensively studied to date. We tested the hypothesis that the presence of fragmented QRS is associated with left ventricular systolic and diastolic dysfunc-
tion determined by extensive echocardiographic parameters.
Methods Patient population and study protocol The current study had a cross-sectional observational design and was conducted between April 2010 and December 2010 at the cardiology clinic of the Rize Education and Research Hospital in Rize, Turkey. The study comprised 259 patients re-
ferred to our outpatient clinic by family physicians for cardiology consultation and risk factor management (hypertension, dyslipidemia, etc.). Patients with recent acute coronary syndrome, significant organic valvular heart disease, any QRS morphology with a QRS duration of 120 ms or more (bundle branch block patterns; left, right bundle branch block, and intraventricular conduction delay) as well as patients with permanent pacemakers were excluded from the study.
Fig. 1 8 Various types of notched and fragmented QRS complexes used for selecting patients in our study. Different fQRS patterns are shown by arrows including rSr’, rSR’, RSr’, notched R up-stroke, notched S down-stroke, bifid R peak, and bifid R nadir Herz 2013
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e-Herz: Original article
Electrocardiography
Tab. 1 Baseline characteristics of the study population Parameters
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