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Relationship between fragmented QRS complexes and left ventricular systolic and diastolic functions

Zusammenhang zwischen fragmentierten QRS-Komplexen und linksventrikulärer systolischer sowie diastolischer Funktion

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Abstract

Background

Fragmented QRS complexes (fQRS) have been associated with increased morbidity and mortality, sudden cardiac death, and recurrent cardiovascular events. The association between left ventricular systolic and diastolic functions and 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 dysfunction.

Methods

The study included 259 patients who were consecutively admitted to our outpatient clinic for cardiovascular risk factor management. Extensive echocardiographic parameters were obtained from all patients and these were compared with the presence and number of fQRS.

Results

Patients with fQRS were of older age (58 ± 12 vs. 55 ± 13 years, p = 0.03) and had prolonged QRS time (105 ± 12 vs. 93 ± 10 ms, p < 0.001) and a higher rate of Q waves on ECG (36% vs. 11%, p < 0.001). In addition, they had worse systolic (lower LVEF%, 44 ± 17 vs. 61 ± 12, p < 0.001) and diastolic functions (DT, 177 ± 77 vs. 211 ± 59 ms, p < 0.001; IVRT, 81 ± 27 vs. 92 ± 22 ms, p = 0.001; Em, 9 ± 4 vs. 10 ± 4 cm/s, p = 0.008; E/Em ratio, 11 ± 5 vs. 8 ± 4, p < 0.001) in comparison to patients with nonfragmented QRS. There was a significant negative correlation between the number of fQRS and left ventricle systolic functions (for LVEF%, r = − 0.595, p < 0.001). After adjustment for age and gender, the number of fQRS remained significantly negatively associated with left ventricular systolic and diastolic functions.

Conclusion

We found that fQRS is related to left ventricular systolic dysfunction and diastolic dysfunction. fQRS, which may be the result of myocardial ischemia or scar on myocardial electrical parameters at the cellular level, may represent inadequate systolic and diastolic functions.

Zusammenfassung

Hintergrund

Fragmentierte QRS-Komplexe (fQRS) wurden mit erhöhter Morbidität und Mortalität, plötzlichem Herztod und rezidivierenden kardiovaskulären Ereignissen in Verbindung gebracht. Der Zusammenhang zwischen linksventrikulärer systolischer und diastolischer Funktion und dem Vorliegen von fQRS ist bisher nicht umfassend untersucht worden. Wir prüften die Hypothese, dass das Vorliegen von fQRS mit linksventrikulärer systolischer und diastolischer Dysfunktion einhergeht.

Methoden

In die Studie wurden 259 Patienten aufgenommen, die sich nacheinander zur ambulanten Behandlung kardiovaskulärer Risikofaktoren in unserer Klinik vorstellten. Von sämtlichen Patienten wurden umfangreiche Echokardiographieparameter erhoben und mit dem Vorliegen und der Anzahl von fQRS verglichen.

Ergebnisse

Patienten mit fQRS wiesen ein höheres Alter (58 ± 12 vs. 55 ± 13 Jahre, p = 0,03), eine verlängerte QRS-Zeit (105 ± 12 vs. 93 ± 10 ms, p < 0,001) und eine höhere Rate an Q-Wellen im EKG auf (36 vs. 11%, p < 0,001). Außerdem war bei ihnen die systolische (geringere linksventrikuläre Ejektionsfraktion, LVEF%: 44 ± 17 vs. 61 ± 12, p < 0,001) und diastolische Funktion schlechter (Dezelerationszeit, DT: 177 ± 77 vs. 211 ± 59 ms, p < 0,001; isovolumetrische Relaxationszeit, IVRT: 81 ± 27 vs. 92 ± 22 ms, p = 0,001; Em: 9 ± 4 vs. 10 ± 4 cm/s, p = 0,008; E/Em-Ratio:11 ± 5 vs. 8 ± 4, p < 0,001) als bei Patienten mit nichtfragmentierten QRS-Komplexen. Es bestand eine signifikante negative Korrelation zwischen der Anzahl von fQRS und der linksventrikulären systolischen Funktion (für LVEF%: r = − 0,595, p < 0,001). Nach Berücksichtigung von Alter und Geschlecht blieb die Anzahl der fQRS in signifikanter Weise negativ mit der linksventrikulären systolischen und diastolischen Funktion vergesellschaftet.

Schlussfolgerung

Wir stellten fest, dass zwischen fQRS und linksventrikulärer systolischer sowie diastolischer Dysfunktion ein Zusammenhang besteht. So sind fQRS, die Auswirkungen einer Myokardischämie oder -narbe auf den elektrischen Zustand des Myokards auf Zellebene darstellen können, möglicherweise Zeichen einer inadäquaten systolischen und diastolischen Funktion.

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Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Cardiology, Rize Education and Research Hospital, 53020, Rize, Turkey

    A. Çanga,  S.A. Kocaman & M. Çetin

  2. Department of Cardiology, Rize University Medical Faculty, Rize, Turkey

    M.E. Durakoğlugil & T. Erdoğan

  3. Department of Cardiology, Ordu State Hospital, Ordu, Turkey

    T. Kırış

  4. Department of Cardiology, Private Medikar Hospital, Karabuk, Turkey

    M. Erden

Authors
  1. A. Çanga
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  2. S.A. Kocaman
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  3. M.E. Durakoğlugil
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  4. M. Çetin
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  5. T. Erdoğan
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  6. T. Kırış
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Correspondence to S.A. Kocaman.

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Çanga, A., Kocaman, S., Durakoğlugil, M. et al. Relationship between fragmented QRS complexes and left ventricular systolic and diastolic functions. Herz 38, 665–670 (2013). https://doi.org/10.1007/s00059-012-3739-1

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  • DOI: https://doi.org/10.1007/s00059-012-3739-1

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