Download Association of fragmented QRS complexes on ECG with left

Association of fragmented QRS complexes on ECG with left ventricular diastolic dysfunction in ST
elevation myocardial infarction
Setiawan Widodo1, Mustika Mahbubi1 , Hasanah Mumpuni2, Erika Maharani3
1
Department Cardiology and Vascular, Faculty of Medicine Universitas Gadjah Mada – Dr. Sardjito
Hospital Yogyakarta, Indonesia
2
Echocardiography Division of Department Cardiology and Vascular, Faculty of Medicine Universitas
Gadjah Mada – Dr. Sardjito Hospital Yogyakarta, Indonesia
3
Arrhythmia Division of Department Cardiology and Vascular, Faculty of Medicine Universitas Gadjah
Mada – Dr. Sardjito Hospital Yogyakarta, Indonesia
Background. Various prior studies have suggested that the region of a myocardial scar is associated with
alteration in QRS morphology, leading to a terminal conduction delay or a fragmentation of QRS
complexes (fQRS). fQRS on ECG signifies myocardial fibrosis in various clinical situations. In the other hand,
interstitial fibrosis is one of the histological characteristic of diastolic dysfunction. Interstitial fibrosis may
be result of myocardial infarction.
Aims. To investigate wheter fQRS on ECG is related to diastolic dysfunction in acute myocardial infarction
patients.
Methods. This study population enrolling 87 patients with ST-elevation acute myocardial infarction. The
inclusion criteria were patients, 18-80 years old, with Acute Myocardial Infarction onset < 12 hours, no
history of infarction, PCI and fibrinolitic. The exclusion criteria were documented atrioventicular block,
chronic heart failure, congenital heart disease, valvular heart disease, consumed amiodaron,verapamil,
phonobarbital and propanolol, got cardiac resynchronization therapy. Fragmented QRS was defined as
the presence of an additional R wave (R’), notching of the R or S wave or fragmentation in two contiguous
leads. Echocardiography was performed to all patients to detect diastolic dysfunction. Cross tabulation
was performed for analysis.
Results. 41% patients had fQRS on ECGs (fQRS + group). The two gropus were similar in term of baseline
characteristics. and there were 59% who did not have fQRS on their ECGs (fQRS - group). In patients with
fQRS on the ECG, diastolic dysfunction was more prevalent (32,5% vs 8,4%, p=0,411). Diastolic dysfunction
did not significantly differ between groups.
Conclusion. The presence of fQRS complexes on ECG didn’t predict diastolic dysfunction in patient ST
elevation myocardial infarction.
Keywords. Fragmented QRS, ST-elevation myocardial infarction, diastolic dysfunction