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Fragmented QRS in a patient with dilated cardiomyopathy. ECG and images from a 74-year-old patient with left ventricular dysfunction (ejection fraction: 32%). The patient was diagnosed as having non-ischemic dilated cardiomyopathy. A) 12-lead ECG showed right bundle branch block, B) fQRS (various RSR' patterns) was present in left lateral and inferior leads, and C) delayed enhancement in Ga-MRI was present in the inferolateral resion (white arrows).
Source publication
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. In patients with CAD, fQRS was associated with myocardial scar detected by single photon emission tomography and was a predictor of cardiac events. fQRS was also a predi...
Contexts in source publication
Context 1
... gadolinium enhancement cardiac magnetic resonance (Ga-MRI) is another tool for identifying the myocardial fibrosis and dysfunction. Abnormal late enhancement of gadolinium in patients with cardiac dilated cardiomyopathy (DCM) [10,11] (Figure 5) or cardiac sarcoidosis [12] or repaired tetralogy of Fallot [13] was associated with the existence of fQRS. Myocardial scar and conduction disturbance result in dyssynchrony in left ventricular systolic function. ...Context 2
... wide QRS complex was observed in 14-47% of patients with heart failure. A wide QRS complex, especially left BBB, is associated with more advanced myocardial injury, worse left ventricular function and higher mortality than those in the case of a narrow QRS complex [31] (Figure 5). Two studies showed that fQRS as well as wide QRS complex was associated with worse prognosis in patients with DCM [7,30]. ...Similar publications
To determine the level of knowledge concerning Sudden Unexpected Death in the Young (SUDY) among Canadian medical students and recent graduates (≤5 years after graduating).
A cross-sectional study was conducted by distributing a standardised, multiple choice, online questionnaire which assessed basic knowledge of SUDY.
Canadian medical schools and...
Citations
... Fragmented QRS is traditionally defined as an additional notch in the QRS complex in the absence of bundle branch block [1][2][3]. The electrophysiological mechanism underlying the pathogenesis of QRS fragmentation has been found to be the existence of complex and nonuniform pathways of myocardial excitation [4,5]. ...
... Electrocardiographic patterns were digitally evaluated by zooming in the lead of interest. The presence of narrow (<120 ms) fragmented QRS in a specific lead of the electrocardiogram was confirmed when there was a QRS with an additional R wave (R ′ ) or notching in the nadir of the R wave or the S wave or the presence of more than one R ′ , with the exception of right bundle branch block pattern in V1 [2,3]. Electrocardiographic measurements included heart rate, PR interval, QRS duration, QT interval, and QRS axis. ...
Background/Objectives: QRS fragmentation has not been linked with increased mortality in individuals without known cardiac disease. We aimed to investigate the physiological determinants of QRS fragmentation in individuals without cardiac disease. Methods: Study participants were 163 (54 athletes, 109 nonathletes) asymptomatic individuals with QRS fragmentation but without cardiac disease. QRS fragmentation was assessed in the supine position after deep inspiration or standing up and during exercise. The changes in QRS fragmentation were evaluated over a median follow-up period of 2.3 (0.8–4.9) years. Results: The most common lead with QRS fragmentation was III (63.0% in athletes, 61.5% in nonathletes), immediately followed by V1 (50.0%) and aVF (42.6%) in athletes and aVF (55.0%) in nonathletes. QRS fragmentation in V1 was more frequent in athletes compared to nonathletes (p < 0.001). Among athletes, the presence of QRS fragmentation in V1 could be independently predicted by increased RVOTproxi (right ventricular outflow tract proximal diameter indexed to body surface area) (p < 0.001). Among individuals with QRS fragmentation in V1, deep inspiration resulted in disappearance of QRS fragmentation more frequently in nonathletes compared to athletes (100% vs. 20%, p = 0.003). Deep inspiration resulted in disappearance of QRS fragmentation in aVF (p < 0.001). The presence of QRS fragmentation in II or aVF was associated with increased body mass index (BMI) (p = 0.003). Among athletes without QRS fragmentation in V1 at baseline, the appearance of QRS fragmentation in V1 at the end of follow-up was associated with greater training age (p = 0.034). Among individuals with QRS fragmentation in aVF at baseline, the disappearance of QRS fragmentation in aVF at the end of follow-up was associated with greater reduction in BMI (p = 0.008). Conclusions: The characteristic feature of QRS fragmentation in athletes was the presence of QRS fragmentation in V1, which was associated with RVOTproxi. The persistence of QRS fragmentation in V1 after deep inspiration could serve as a specific marker of exercise-training-related cardiac adaptation. The presence of QRS fragmentation in the leads of the frontal plane was influenced by BMI and respiration phase.
... [8] The clinical importance of fQRS is also endeavored to get revealed using a series of studies that evaluate CVD and cardiomyopathies or certain diseases originating from other systems apart from the cardiovascular system, such as obstructive sleep apnea, cirrhosis, and renal diseases. [9,10] Aim Our aim in our study is to determine whether there is a significant difference in the demographic and clinical characteristics of STEMI patients who have undergone percutaneous coronary intervention (PCI) and the frequency of inhospital adverse events in relation to the presence or absence of fQRS, and to ascertain the possible association of thrombolysis in myocardial infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) scores and certain parameters with increased likelihood of developing major adverse cardiac events in the entire patient group. ...
... Our results would therefore be consistent with these data when considering KO males, especially since, at the molecular level, we had observed a trend towards an increase in cardiac fibrotic markers (Supplementary Fig. 3). It should be noted that males displayed a tendency towards increased QRS complex amplitude, which could be associated with conductance defects and in cases of advanced pathology and to myocardial scarring resulting from accumulation of fibrotic tissue following cardiac trauma 52 . However, no histopathological signs associated with fibrosis were observed, but this does not exclude the fact that it could have been the case if mice were followed for longer than 14 weeks. ...
Lean patients with NAFLD may develop cardiac complications independently of pre-existent metabolic disruptions and comorbidities. To address the underlying mechanisms independent of the development of obesity, we used a murine model of hepatic mitochondrial deficiency. The liver-heart axis was studied as these mice develop microvesicular steatosis without obesity. Our results unveil a sex-dependent phenotypic remodeling beyond liver damage. Males, more than females, show fasting hypoglycemia and increased insulin sensitivity. They exhibit diastolic dysfunction, remodeling of the circulating lipoproteins and cardiac lipidome. Conversely, females do not manifest cardiac dysfunction but exhibit cardiometabolic impairments supported by impaired mitochondrial integrity and β-oxidation, remodeling of circulating lipoproteins and intracardiac accumulation of deleterious triglycerides. This study underscores metabolic defects in the liver resulting in significant sex-dependent cardiac abnormalities independent of obesity. This experimental model may prove useful to better understand the sex-related variability, notably in the heart, involved in the progression of lean-NAFLD.
... It has been demonstrated that fQRS reflects an abnormality in intraventricular depolarization and myocardial activation, which result from heterogeneous conduction characteristics of injured myocardium due to the formation of scar and/or fibrous tissue. 59,60 Accumulating studies have suggested that fQRS could be considered a novel ECG marker for the detection of myocardial scar and fibrosis with more sensitivity and less specificity than Q wave, in a varied spectrum of cardiac disorders. 13,61,62 Fibrosis of the ventricular myocardium is the main pathologic characteristic in various types of nonischemic cardiomyopathies, including DCM, ARVC, LVNC, HCM, and RCM, 63,64 and is independently related to poor prognosis. ...
Background and Aims
Fragmented QRS (fQRS), which is associated with rhythm disturbances, can predispose the heart to fatal ventricular arrhythmias. Recently, accumulating studies indicates that fQRS is associated with poor prognosis in various types of cardiomyopathies. Therefore, we assessed the association between fQRS with all‐cause mortality and major arrhythmic events (MAEs) in patients with nonischemic cardiomyopathy, in this systematic review and meta‐analysis study.
Methods
We performed a comprehensive search in databases of PubMed/Medline, EMBASE, and Web of Science from the beginning to December 31, 2022. Published observational studies (cohorts, case–control, or analytical cross‐sectional studies) were included that report the prognostic value of fQRS in patients with different types of nonischemic cardiomyopathies for MAEs (sudden cardiac death, sudden cardiac arrest, sustained ventricular tachycardia [VT], ventricular fibrillation [VF], and appropriate shock) and all‐cause mortality. We pooled risk ratios (RRs) through raw data and adjusted hazard ratios (aHRs) using “Comprehensive Meta‐Analysis” software, Version 2.0.
Results
Nineteen cohort and three analytical cross‐sectional studies were included in this meta‐analysis involving a total of 4318 subjects with nonischemic cardiomyopathy (1279 with fQRS and 3039 without fQRS). FQRS was significantly associated with an increased risk of all‐cause mortality in patients with nonischemic cardiomyopathy (pooled RR: 1.920; 95% confidence interval [CI]: 1.388–2.656, p < 0.0001/pooled HR: 1.729; 95% CI: 1.327–2.251, p < 0.0001). Also, the risk of developing MAEs in the presence of fQRS was significantly increased (pooled RR: 2.041; 95% CI: 1.644–2.533, p < 0.0001/pooled HR: 3.626; 95% CI: 2.119–6.204, p < 0.0001). In the subgroup analysis, the strongest association between fQRS presence and increased MAEs was observed in patients with hypertrophic cardiomyopathy (HCM) (pooled RR: 3.44; 95% CI: 2.07–5.71, p < 0.0001/pooled HR: 3.21; 95% CI: 2.04–5.06, p < 0.0001).
Conclusion
Fragmented QRS could be a prognostic marker for all‐cause mortality and MAEs in patients with various types of nonischemic cardiomyopathies, particularly HCM.
... In agreement with our results, Dhote et al. [55] demonstrated that females with ovariectomy and ischemia show ST-segment elevation until reperfusion. fQRS (Fig. 3I), characterized by additional peaks in the QRS complex [56,57], indicates myocardial scars and is prognostic of ventricular dysfunction [58]. Additionally, the increase in QRS complex amplitude in the Ovx 20 w groups (Table 3) is associated with delayed electrical impulse propagation due to interstitial fibrosis [59]. ...
Background:
Cardiovascular diseases (CVDs) are the leading cause of women's mortality, linked to aging and reduced estrogen during menopause. Estrogen replacement therapy (ERT) is suggested for CVDs prevention. Yet, its timing initiation remains contentious. Thus, we aimed to evaluate the effect of early and late estrogen therapy on cardiac function and lipid metabolism in ovariectomized old female Wistar rats.
Methods:
Fifty randomized female Wistar rats were included in 5 groups (n = 10, 18 months old): (1) Sham, (2) 10 weeks post ovariectomy (Ovx-10 w), (3) 10 weeks post Ovx + early estrogen replacement therapy (Ovx 10 w-early ERT), (4) 20 weeks post Ovx (Ovx-20 w) and (5) Ovx 20 w-late ERT. Three days (early ERT) or 10 weeks (late ERT) after surgery 17-β estradiol was given (5 µg/kg/day), and 10 weeks after the start of ERT, we assessed cardiac function by echocardiography, electrocardiography, and cardiac catheterization. Estradiol, cholesterol, triglyceride (TG), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels were determined. Cardiac histology was performed with Masson's staining.
Results:
Ovariectomy (Ovx) increases left ventricle internal systolic diameter (0.4 vs 0.3 cm, *p = 0.020) and decreases shortening fraction (40 vs 54 %, *p = 0.030) regardless of therapy. ERT prevents the increase in left ventricle mass after 10 weeks post-Ovx and the ejection fractionreduction after 20 weeks. Lower P wave amplitudes (18.8 vs 24.2 ms, *p = 0.013) were found in the Ovx-20 w group. A longer duration of the QRS complex after 20 weeks post-Ovx with and without ERT was found (32.5 and 32.1 vs 28.3 ms, *p = 0.003; *p = 0.007). Diastolic blood pressure was higher 20 weeks post-Ovx (86 vs 76 mmHg, *p = 0.047), regardless of ERT. The left ventricle (LV) -dP/dt was decreased in Ovx groups without ERT (-750 vs -1320 mmHg, *p = 0.034). An increase in LV collagen deposition was found in the Ovx 10 w group vs Sham (9.58 vs 4.54 %, *p = 0.028). Early ERT avoids the increase in body weight, cholesterol and LDL caused by Ovx.
Conclusions:
Ovariectomy causes time-dependent alterations in lipid metabolism, morphology, electrical activity, and heart contractile function. Early but not late ERT prevents some of these effects.
... Fragmented QRS on the ECG is a straightforward, affordable, and widely accessible indicator of myocardial fibrosis and scarring (10,11). Fragmented QRS is linked to HF and is a risk factor for death and arrhythmic events in some conditions (12,13). ...
Background: Fragmented QRS (fQRS) on the ECG is a straightforward, affordable, and widely accessible indicator of myocardial fibrosis and scarring. Aim: This study aimed to assess the predictive value of (fQRS) in diagnosing myocardial ischemia. It evaluated its incremental prognostic significance in patients having single-photon emission computed tomography (SPECT) for exercise-induced myocardial ischemia. Methods: This observational case-control research was executed on 206 patients who underwent exercise myocardial perfusion SPECT for suspected stable chronic CAD. All patients were subjected to demographic, clinical, and laboratory data, electrocardiography, echocardiography, and SPECT myocardial perfusion imaging. The existence of fQRS was determined based on electrocardiographic criteria. Multivariate logistic regression analysis was applied to predict myocardial ischemia, and the incremental prognostic value of fQRS was determined utilizing hierarchical regression analysis. Results: The patients had a mean age of 53 ±10 years, and more than one-quarter (28.2%) had fQRS. Patients with myocardial ischemia (Group I) had a greater prevalence of fQRS than the control group fQRS (42.3% vs. 23.4%, P = 0.009). In multivariate analysis, fQRS significantly predicted myocardial ischemia (OR = 2.298, 95% CI = 1.102-4.792, P = 0.026). Furthermore, compared to traditional risk factors and a combination of conventional risk factors and STT alterations, the fQRS demonstrated an added predictive value (Global X 2 = 34.612). Conclusions: Fragmented QRS complex is a promising ECG marker significantly associated with myocardial ischemia. Its inclusion in risk assessment models enhances predictive accuracy, aiding early CAD diagnosis and risk stratification in patients with stable chronic coronary artery disease
... fQRS has been traditionally described as a marker of conduction delay that may represent an abnormal area of the myocardium, thus predisposing to a greater arrhythmic risk in patients with heart disease [21]. Indeed, the underlying substrate of the fQRS could be linked to the presence of a myocardial scar, reflecting the inhomogeneous activation of the ventricles [24,25]. Some authors described the fQRS as a sign of myocardial perfusion deficit [26], linking this pattern to specific heart diseases like sarcoidosis [27]. ...
Differentiating between ECG patterns related to athletes' heart remodeling and pathological findings is a challenge in sports cardiology. As the significance of fragmented complex in athletes remains uncertain, this study aimed to assess the presence of fragmented QRS in lead V1 (fQRSV1) among young athletes and its association with heart adaptations and arrhythmias. Young athletes referred for annual pre-participation screening receiving a maximal exercise testing and transthoracic echocardiography from January 2015 to March 2021 were included. The study included 684 young athletes. The prevalence of fQRSV1 was 33%. Subjects with fQRSV1 had higher exercise capacity and indexes of right ventricular function and remodeling. Among highly trained athletes, the fQRSV1 group demonstrated also increased left ventricular wall thickness. No significant association existed between fQRSV1 and exercise-induced arrhythmias, even in highly trained athletes. The high prevalence of fQRSV1 in young athletes is associated with training-induced heart adaptations but not exercise-induced ventricular arrhythmias.
Graphical Abstract
The fragmented QRS complex in lead V1 in young athletes. PPS = preparticipation screening; EST = exercise stress test; fQRSV1 = fragmented QRS in lead V1; PSBs = premature supraventricular beats; PVBs = premature ventricular beats.
... Fragmented QRS (fQRS) is a suitable marker of myocardial scar that is assessed by 12-lead Electrocardiogram (ECG) evaluation. FQRS is detected when the additional notches in the QRS complex become revealed (1). It is typically defined as the presence of additional notches in the R or S waves in the absence of Bundle Branch Block (BBB) or as an RSR' pattern in the original QRS wave (with a duration of <120 ms) (2). ...
Background: Fragmented QRS (fQRS) on electrocardiography is a marker of myocardial fibrosis and scar formation. We aimed to investigate whether the fQRS complex in children with and without obesity correlates with Body Mass Index (BMI). Methods: In this cross-sectional study, 104 children (5 to 17 years) referred to the pediatric clinic were studied. We divided participants into normal and obese groups. Standard 12-lead ECGs, anthropometric data, and blood pressure were recorded. All ECGs were analyzed blindly by two independent clinicians. Surveyed parameters of the ECG included heart rate, QRS duration, QT interval, presence of Q waves, and fQRS. Results: Among 104 participants, 52 patients had normal BMI and 52 cases were obese. Systolic blood pressure (p=0.001), pulse pressure (p=0.007), mean blood pressure (p=0.006), and heart rate (p=0.009) were meaningfully different between the two groups. We found fQRS in four children with obesity. The frequency of fQRS was significantly different between children with obesity and children in the control group (p=0.041). We have found that each unit change of weight and BMI at 1.07 and 1.45, respectively, could be useful in prediction of the occurrence of fQRS complex in children. Conclusion: This study suggested a significant association between the fQRS in children’s ECG and their weight and BMI. It would appear that each unit increasing weight and BMI predicts an increasing the occurrence of fQRS. The ECG may consider using fQRS as a cardiac risk marker in children with obesity.
... The fQRS is a finding associated with an increased cardiovascular risk due to coronary artery disease (CAD). [4] Several studies have shown an association between the increase in the number of leads with fQRS and the degree of myocardial fibrosis, cardiovascular morbidity, and mortality. [5] Coronary artery disease is one of the leading causes of cardiovascular morbidity and mortality. ...
Objectives: This study aims to investigate the preoperative electrocardiographic data of patients who were candidates for elective coronary artery bypass grafting (CABG) in terms of fragmented QRS (fQRS) presence and to evaluate short-term outcomes of fQRS on operative and postoperative courses. Patients and methods: Between January 2019 and April 2022, a total of 178 patients (137 males, 41 females; mean age: 61.4±9.3 years; range, 39 to 85 years) who underwent elective CABG were retrospectively analyzed. Preoperative electrocardiographic examinations were performed to detect fQRS. The patients were divided into two groups according to presence of fQRS as the fQRS+ (n=35) and fQRS– (n=143) group. Demographic, clinical, laboratory, operative, and postoperative data of both groups were evaluated. Results: The mean duration of cardiopulmonary bypass (p=0.017) and number of CABG (p=0.026) in the fQRS group were found to be significantly higher, while the mean preoperative left ventricular ejection fraction values were lower in this group (p<0.001). There was a significant increase in the left ventricular ejection fraction values at the postoperative third month in the fQRS+ group (p<0.001). Mortality encountered in 5.7% in the fQRS+ group, while this rate was 2.7% in the fQRS– group (p=0.336). Conclusion: Preoperative detection of QRS fragmentations on admission electrocardiograms may have an additional value in predicting postoperative cardiac status and short-term prognosis in patients undergoing CABG.
... Fragmented QRS (fQRS) is identified by a 12lead electrocardiogram (ECG) as a result of an intraventricular conduction defect (1). The fQRS is a convenient marker of myocardial scar (1). ...
... Fragmented QRS (fQRS) is identified by a 12lead electrocardiogram (ECG) as a result of an intraventricular conduction defect (1). The fQRS is a convenient marker of myocardial scar (1). fQRS can be defined as additional R′ waves or a notch in the nadir of the R or S wave in 2 contiguous leads corresponding to a coronary territory in a 12-lead ECG (2). ...
... fQRS can be defined as additional R′ waves or a notch in the nadir of the R or S wave in 2 contiguous leads corresponding to a coronary territory in a 12-lead ECG (2). Data suggests that fQRS can predict cardiac events and mortality in various heart diseases (1). It is related to various cardiac conditions like coronary artery disease (CAD), cardiomyopathies, valvular heart disease, aortic dissection, and pulmonary embolism (1,2). ...
