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Fragmented QRS on 12-lead electrocardiogram predicts long-term prognosis in patients with cardiac sarcoidosis

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Abstract

Fragmented QRS (fQRS) on a 12-lead electrocardiogram is a known marker of fatal arrhythmias or cardiac adverse events in ischemic and non-ischemic cardiomyopathy patients. Nonetheless, the association between fQRS and clinical outcomes in patients with cardiac sarcoidosis (CS) remains unclear. Herein, we investigated whether fQRS is associated with long-term clinical outcomes in CS patients. A total of 78 patients who received immunosuppressive therapy (IST) for clinically diagnosed CS were retrospectively examined. Patients were classified into two groups according to the presence (n = 19) or absence (n = 59) of fQRS on electrocardiogram before IST. The primary outcome was the composite event of all-cause death, ventricular tachyarrhythmias (VTs), and hospitalization for heart failure. Results of late gadolinium enhancement on cardiac magnetic resonance imaging were also analyzed. During a median follow-up period of 3.7 years (interquartile range: 1.6–6.2 years), the primary outcome occurred more frequently in patients with fQRS than in those without (47% vs. 13%, log-rank p = 0.002). Multivariable Cox regression analyses showed that fQRS was an independent determinant of the primary outcome. The incidence of VTs, within 12 months of IST initiation, was comparable between the two groups; however, late-onset VTs, defined as those occurring ≥ 12 months after IST initiation, occurred more frequently in the fQRS group (21% vs. 2%, log-rank p = 0.002). The scar zone and scar border zone were greater in patients with fQRS than in those without it. In conclusion, our analysis suggests that fQRS is an independent predictor of adverse events, particularly late-onset VTs, in patients with CS.

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The data underlying this article cannot be shared publicly due to the privacy of individuals that participated in the study. The data will be shared on reasonable request to the corresponding author.

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Acknowledgements

The authors wish to thank all the investigators, clinical research coordinators, and data managers for their contributions. We would like to thank Mr. John Martin for English language editing.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan

    Hikaru Hagiwara, Masaya Watanabe, Takahide Kadosaka, Takuya Koizumi, Yuta Kobayashi, Taro Koya, Motoki Nakao, Yoshiya Kato, Rui Kamada, Toshiyuki Nagai & Toshihisa Anzai

  2. Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-Ku, Sapporo, 060-8638, Japan

    Satonori Tsuneta & Kohsuke Kudo

  3. Department of Cardiovascular Medicine, Kushiro City General Hospital, Kushiro, Japan

    Hikaru Hagiwara, Yoshiya Kato & Hirokazu Komoriyama

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  1. Hikaru Hagiwara
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Correspondence to Masaya Watanabe.

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Hagiwara, H., Watanabe, M., Kadosaka, T. et al. Fragmented QRS on 12-lead electrocardiogram predicts long-term prognosis in patients with cardiac sarcoidosis. Heart Vessels 38, 803–816 (2023). https://doi.org/10.1007/s00380-022-02229-2

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