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Fragmented QRS complexes not typical of a bundle branch block: A marker of greater myocardial perfusion tomography abnormalities in coronary artery disease

  • Original Articles
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Fragmented QRS (FQRS) complexes, not typical of a bundle branch block, are a marker of regional myocardial injury. The extent of stress myocardial perfusion imaging (MPI) abnormalities with FQRS patterns is not known.

Methods and Results

Twelve-lead electrocardiograms (ECGs) in 501 patients undergoing stress MPI were studied. FQRS was defined as a QRS duration of 120 milliseconds or less, with notches or slurs of QRS complexes, on 2 contiguous leads of a coronary artery territory. Abnormal MPI was defined as a regional summed stress score (SSS) and summed rest score (SRS) of 3 or greater based on a 17-segment model. Patients with a typical bundle (n=26), paced rhythm (n=2), and Q waves (n=64) were excluded. Of the remaining 409 patients (mean age, 58±13 years; 52% male), 155 (38%) had FQRS on the ECG. FQRS patients had a higher mean SSS, SRS, and global summed difference score and a lower left ventricular ejection fraction (all P<.001), as well as greater regional stress MPI scar (69% vs 11%, P<.001), FQRS pattern sensitivity was 75% and specificity was 94% for a corresponding regional MPI scar. On logistic regression, SSS, SRS, summed difference score, left ventricular ejection fraction, and regional scar were univariate predictors of the FQRS pattern on the ECG (all P<.01), and any regional scar (odds ratio, 32; P<.001) was a multivariate predictor.

Conclusions

FQRS complexes on an ECG are a marker of higher stress MPI perfusion and functional abnormalities. Regional FQRS patterns denote the presence of a greater corresponding focal regional myocardial scar on stress MPI

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Authors and Affiliations

  1. Krannert Institute of Cardiology, Indiana University School of Medicine, MPC-2, 1801 N Senate Blvd, 46202, Indianapolis, IN

    Jo Mahenthiran, Bilal R. Khan, Stephen G. Sawada & Mithilesh K. Das

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  1. Jo Mahenthiran
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  2. Bilal R. Khan
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  3. Stephen G. Sawada
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  4. Mithilesh K. Das
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Correspondence to Jo Mahenthiran.

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Mahenthiran, J., Khan, B.R., Sawada, S.G. et al. 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 (2007). https://doi.org/10.1016/j.nuclcard.2007.02.003

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  • DOI: https://doi.org/10.1016/j.nuclcard.2007.02.003

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