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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