Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Association of QRS Fragmentation and Left Ventricular Dysfunction in Heart Failure Patients I. A. Pratiwi, A. A. Siregar, Z. Safri Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia; Department of Cardiology and Vascular Medicine, Haji Adam Malik General Hospital, Medan, Indonesia Abstract Objective: Fragmented QRS (FQRS) is a convenient marker of myocardial scar evaluated by 12-lead electrocardiogram (ECG) recording. FQRS is defined as additional spikes within the QRS complex. FQRS was recently correlated with various outcomes in ischemic and nonischemic heart disease. We hypothesized that the presence of FQRS would be associated with worse NYHA functional class and lower ejection fraction (EF) in heart failure (HF) patients of any cause. Methods: A total of 90 HF patients due to ischemic or nonischemic, admitted from January until Desember 2014 at Cardiology and Vascular Medicine Department Haji Adam Malik General Hospital were retrospectively analyzed. Patients were divided into two groups based on the presence of FQRS on admisison ECG. ECGs were read twice by a reader blinded to all data. FQRS defined as additional spikes within the QRS complex in at least two of the extremity and or precordial leads. Patients with AV block, bundle branch block (BBB), and with pacemaker were excluded. Bivariate and multivariate analysis were performed to study the association between FQRS and ventricular contraction dysfunction, p value <0.05 was considered statistically significant. Results: Patients were classifed as FQRS group (n=50; mean age, 55.4±10.1 years) and nonFQRS group (n=40; mean age, 54.1±14.6 years). FQRS on ECG was significantly correlated with higher number of leads with FQRS, FQRS involving ≥1 ECG areas, lower EF (<40%) and higher left ventricular end systolic dimension (LVESD) (47.1±11.7, mm) (p<0.001). There was significant difference in EF between patients with FQRS and non-FQRS group (p <0.001). Conclusion: The occurrence of FQRS is beneficial to identify the patients with left ventricular contraction dysfunction. Presence of FQRS is associated with lower EF (<40%) in HF patients. This was mainly seen in patients with FQRS involving ≥6 leads and ≥1 ECG areas. Keywords: fragmented QRS, heart failure, ejection fraction