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The role of fQRS in coronary artery disease

A meta-analysis of observational studies

Rolle des fQRS bei der koronaren Herzkrankheit

Eine Metaanalyse von Beobachtungsstudien

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Abstract

Background

Experimental and clinical studies have suggested that the presence of fragmented QRS complex (fQRS) is associated with various cardiovascular diseases. fQRS may predict major adverse cardiovascular events (MACE). The current meta-analysis was performed using clinical outcome studies to evaluate the role of fQRS in coronary artery disease (CAD).

Methods

A systematic search of electronic databases (Cochrane, Medline, Embase and Pubmed) from their inception to April 2014 was performed. Data were extracted from applicable articles to evaluate the prognostic value of fQRS in CAD.

Results

A total of 16 observational studies about fQRS and CAD (n = 3,997 patients) were identified. Compared with the non-fQRS group, MACE and mortality were significantly higher in the fQRS group —odds ratios (OR) 3.19, 95 % confidence interval (95 % CI) [2.3, 4.42], p < 0.00001; OR 2.24, 95 % CI [1.71, 2.94], p < 0.0001. Patients developed Q waves, anterior-wall myocardial infarction (MI), and low left ventricular ejection fraction (LVEF) more frequently in the fQRS group than in the non-fQRS group—OR 2.59, 95 % CI [1.76, 3.81], p < 0.00001; OR 2.43, 95 % CI [1.07, 5.52], p = 0.03; OR − 6.43, 95 % CI [− 9.11, − 3.74], p < 0.00001.

Conclusion

Based on current evidence, fQRS was associated with increased MACE, mortality, Q waves, anterior-wall MI, and decreased LVEF in CAD. These findings show that fQRS is a reliable marker in CAD.

Zusammenfassung

Hintergrund

Experimentelle und klinische Studien liefern Hinweise, dass das Vorliegen eines fragmentierten QRS-Komplexes (fQRS) mit verschiedenen kardiovaskulären Erkrankungen in Zusammenhang steht. Ein fQRS prognostiziert möglicherweise schwere unerwünschte kardiovaskuläre Ereignisse („major adverse cardiovascular events“, MACE). Die vorliegende Metaanalyse wurde anhand klinischer Outcome-Studien durchgeführt, um die Rolle des fQRS bei der koronaren Herzkrankheit (KHK) zu untersuchen.

Methoden

In elektronischen Datenbanken (Cochrane, Medline, Embase und Pubmed) erfolgte von ihrem Beginn bis zum April 2014 eine systematische Suche. Aus geeigneten Artikeln wurden Daten extrahiert, um den prognostischen Wert des fQRS bei KHK zu ermitteln.

Ergebnisse

Insgesamt wurden 16 Beobachtungsstudien zu fQRS und CAD (n = 3997 Patienten) gefunden. Gegenüber der Gruppe ohne fQRS waren MACE und Mortalität in der fQRS-Gruppe signifikant höher (Odds Ratio, OR: 3,19; 95%-Konfidenzintervall, 95%-KI: 2,3–4,42; p < 0,00001; OR: 2,24; 95%-KI: 1,71–2,94; p < 0,0001). Bei den Patienten in der fQRS-Gruppe traten häufiger Q-Wellen, ein Herzinfarkt mit Lokalisierung an der Vorderwand und eine niedrigere linksventrikuläre Ejektionsfraktion (LVEF) auf als in der Gruppe ohne fQRS (OR: 2,59; 95%-KI: 1,76–3,81; p < 0,00001; OR: 2,43; 95%-KI: 1,07–5,52; p = 0,03; OR: − 6,43; 95%-KI: − 9,11; − 3,74; p < 0,00001).

Schlussfolgerung

Gemäß der aktuellen Datenlage stand eine fQRS mit einer erhöhten Rate von MACE, Mortalität, Q-Wellen und Herzinfarkten mit Lokalisation an der Vorderwand sowie mit einer niedrigeren LVEF bei KHK in Zusammenhang. Diese Ergebnisse zeigen, dass ein fQRS ein verlässlicher Marker bei KHK ist.

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References

  1. O’Keefe JH, Bybee KA, Lavie CJ et al (2012) ST-segment elevation: defined by the company it keeps. Mayo Clin Proc 87:610–613

    Article  Google Scholar 

  2. Das MK, Saha C, El Masry H et al (2007) Fragmented QRS on a 12-lead ECG: a predictor of mortality and cardiac events in patients with coronary artery disease. Heart Rhythm 4:1385–1392

    Article  PubMed  Google Scholar 

  3. Das MK, Michael MA, Suradi H et al (2009) Usefulness of fragmented QRS on a 12-lead electrocardiogram in acute coronary syndrome for predicting mortality. Am J Cardiol 104:1631–1637

    Article  PubMed  Google Scholar 

  4. Pietrasik G, Goldenberg I, Zdzienicka J et al (2007) Prognostic significance of fragmented QRS complex for predicting the risk of recurrent cardiac events in patients with q-wave myocardial infarction. Am J Cardiol 100:583–586

    Article  PubMed  Google Scholar 

  5. Das MK, Suradi H, Maskoun W et al (2008) Fragmented wide QRS on a 12-lead ECG: a sign of myocardial scar and poor prognosis. Circ Arrhythm Electrophysiol 1:258–268

    Article  PubMed  Google Scholar 

  6. Wang DD, Buerkel DM, Corbett JR et al (2010) Fragmented QRS complex has poor sensitivity in detecting myocardial scar. Ann Noninvasive Electrocardiol 15:308–314

    Article  PubMed  Google Scholar 

  7. Guo R, Li Y, Xu Y et al (2012) Significance of fragmented QRS complexes for identifying culprit lesions in patients with non-ST-elevation myocardial infarction: a single-center, retrospective analysis of 183 cases. BMC Cardiovasc Disord 12:44

    Article  PubMed Central  PubMed  Google Scholar 

  8. Lorgis L, Jourda F, Hachet O et al (2013) Prognostic value of fragmented QRS on a 12-lead ECG in patients with acute myocardial infarction. Heart Lung 42:326–331

    Article  PubMed  Google Scholar 

  9. Erdem FH, Tavil Y, Yazici H et al (2013) Association of fragmented QRS complex with myocardial reperfusion in acute ST-elevated myocardial infarction. Ann Noninvasive Electrocardiol 18:69–74

    Article  PubMed  Google Scholar 

  10. Wells G, Shea B, O’Connell D et al (n.d.) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa Health Research Institute. http//www.ohri.ca/programs/clinical_epidemiology/oxford.asp

  11. Mai J, Li H, Fang J et al (2006) Estimation of fail-safe number in meta-analysis. J Evid Based Med 6:297–303

    Google Scholar 

  12. Das MK, Khan B, Jacob S et al (2006) Significance of a fragmented QRS complex versus a Q wave in patients with coronary artery disease. Circulation 113:2495–2501

    Article  PubMed  Google Scholar 

  13. Cetin M, Kocaman SA, Canga A et al (2012) The independent relationship between systemic inflammation and fragmented QRS complexes in patients with stable angina pectoris. Kardiol Pol 70:668–675

    PubMed  Google Scholar 

  14. Guo R, Zhang J, Li Y et al (2012) Prognostic significance of fragmented QRS in patients with non-ST elevation myocardial infarction. Results of a 1-year, single-center follow-up. Herz 37:789–795

    Article  CAS  PubMed  Google Scholar 

  15. Lorgis L, Cochet A, Chevallier O et al (2014) 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 30:204–210

    Article  PubMed  Google Scholar 

  16. Cetin M, Kocaman SA, Erdogan T et al (2012) The independent relationship of systemic inflammation with fragmented QRS complexes in patients with acute coronary syndromes. Korean Circ J 42:449–457

    Article  PubMed Central  PubMed  Google Scholar 

  17. Cetin M, Kocaman SA, Kiris T et al (2012) Absence and resolution of fragmented QRS predict reversible myocardial ischemia with higher probability of ST segment resolution in patients with ST segment elevation myocardial infarction. Korean Circ J 42:674–683

    Article  PubMed Central  PubMed  Google Scholar 

  18. Ari H, Cetinkaya S, Ari S et al (2012) The prognostic significance of a fragmented QRS complex after primary percutaneous coronary intervention. Heart Vessels 27:20–28

    Article  PubMed  Google Scholar 

  19. Erdogan T, Cetin M, Kocaman SA et al (2012) Relationship of fragmented QRS with prognostic markers and in-hospital MACE in patients undergoing CABG. Scand Cardiovasc J 46:107–113

    Article  PubMed  Google Scholar 

  20. Yan GH, Wang M, Yiu KH et al (2012) Subclinical left ventricular dysfunction revealed by circumferential 2D strain imaging in patients with coronary artery disease and fragmented QRS complex. Heart Rhythm 9:928–935

    Article  PubMed  Google Scholar 

  21. Akbarzadeh F, Pourafkari L, Ghaffari S et al (2013) Predictive value of the fragmented QRS complex in 6-month mortality and morbidity following acute coronary syndrome. Int J Gen Med 6:399–404

    PubMed Central  PubMed  Google Scholar 

  22. Sheng QH, Hsu CC, Li JP et al (2014) Correlation between fragmented QRS and the short-term prognosis of patients with acute myocardial infarction. J Zhejiang Univ Sci B 15:67–74

    Article  PubMed Central  PubMed  Google Scholar 

  23. Ahn MS, Kim JB, Yoo BS et al (2013) Fragmented QRS complexes are not hallmarks of myocardial injury as detected by cardiac magnetic resonance imaging in patients with acute myocardial infarction. Int J Cardiol 168:2008–2013

    Article  PubMed  Google Scholar 

  24. Kocaman SA, Cetin M, Kiris T et al (2012) The importance of fragmented QRS complexes in prediction of myocardial infarction and reperfusion parameters in patients undergoing primary percutaneous coronary intervention. Turk Kardiyol Dern Ars 40:213–222

    Article  PubMed  Google Scholar 

  25. Ozdemir S, Tan YZ, Colkesen Y et al (2013) Comparison of fragmented QRS and myocardial perfusion-gated SPECT findings. Nucl Med Commun 34:1107–1115

    Article  PubMed  Google Scholar 

  26. Ozcan F, Turak O, Canpolat U et al (2014) Myocardial tissue perfusion predicts the evolution of fragmented QRS in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Ann Noninvasive Electrocardiol 00(0):1–8

    Google Scholar 

  27. Das MK, Maskoun W, Shen C et al (2010) Fragmented QRS on twelve-lead electrocardiogram predicts arrhythmic events in patients with ischemic and nonischemic cardiomyopathy. Heart Rhythm 7:74–80

    Article  PubMed  Google Scholar 

  28. Take Y, Morita H (2012) Fragmented QRS: what is the meaning? Indian Pacing Electrophysiol J 12:213–225

    PubMed Central  PubMed  Google Scholar 

  29. Tigen K, Karaahmet T, Gurel E et al (2009) The utility of fragmented QRS complexes to predict significant intraventricular dyssynchrony in nonischemic dilated cardiomyopathy patients with a narrow QRS interval. Can J Cardiol 25:517–522

    Article  PubMed Central  PubMed  Google Scholar 

  30. Celikyurt U, Agacdiken A, Sahin T et al (2012) Relationship between fragmented QRS and response to cardiac resynchronization therapy. J Interv Card Electrophysiol 35:337–342

    Article  PubMed  Google Scholar 

  31. Mahenthiran J, Khan BR, Sawada SG et al (2007) Fragmented QRS complexes not typical of a bundle branch block: a marker of greater myocardial perfusion tomography abnormalities in coronary artery disease. J Nucl Cardiol 14:347–353

    Article  PubMed  Google Scholar 

  32. Celikyurt U, Agacdiken A, Sahin T et al (2012) Relationship between fragmented QRS and response to cardiac resynchronization therapy. J Interv Card Electrophysiol 35(3):337–342

    Article  PubMed  Google Scholar 

Download references

Compliance with ethical guidelines

Conflict of interest. Y. Xu, Z. Qiu, Y. Xu, H. Bao, S. Gao, and X. Cheng state that there are no conflicts of interest. The accompanying manuscript does not include studies on humans or animals.

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Authors and Affiliations

  1. Department of Cardiology, Institute of Cardiovascular disease, Second Affiliated Hospital of Nanchang University, 1 Minde Road, 330006, Nan Chang, Jiang Xi, China

    Y. Xu, Y. Xu, H. Bao & X. Cheng

  2. Department of Orthopedics, Second Affiliated Hospital of Nanchang University, Nanchang Jiangxi, China

    Z. Qiu

  3. The Center for Cardiovascular Biology and Atherosclerosis Research, University of Texas Health Science Center at Houston, Houston, TX, USA

    S. Gao

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  1. Y. Xu
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  2. Z. Qiu
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  6. X. Cheng
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Corresponding author

Correspondence to X. Cheng.

Additional information

Y. Xu and Z. Qiu contributed equally to this work and should be considered co-first authors.

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Xu, Y., Qiu, Z., Xu, Y. et al. The role of fQRS in coronary artery disease. Herz 40 (Suppl 1), 8–15 (2015). https://doi.org/10.1007/s00059-014-4155-5

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