Author + information
- Zülkif Tanrıverdi1,
- Mustafa Aytek Şimşek2,
- Hüseyin Dursun1,
- Barış Ünal1,
- Ümmü Tas1,
- Efe Edem3,
- Fatih Aytemiz4,
- İlhan Koyuncu5,
- Mehmet Akif Ekinci6,
- Mehmet Eyüboğlu7,
- Ömer Kozan1 and
- Dayimi Kaya1
Fragmented QRS (fQRS) is defined as QRS notchings resembling conduction delay in at least 2 neighbouring derivations on 12 derivation surface ECG in the absence of bundle branch block pattern. There are several studies that showed this ECG finding to be related with long term mortality of patients with coronary artery disease. As far as we know there's no study evaluating the relationship between fQRS presence and in hospital mortality in acute ST elevated myocardial infarction (STEMI). Aim of our study is to investigate the relationship between fQRS presence and in hospital mortality in patients admitting for the first time with acute STEMI.
248 patients admitted for to Dokuz Eylul University Hospital Cardiology Department fort he first time with acute STEMI between 01 January 2009 and 01 July 2011 are included in our study. Patients having ECG findings that can be misdiagnosed as fQRS [ incomplete right bundle branch block pattern in V1, pacemaker rhytm, wide QRS complex (QRS >120 ms)] and with CABG history are excluded. All 12 derivation ECG recordings on admission and in 48 hours of admission are investigated fort he presence of fQRS. Presence of fQRS is defined as presence of more than one R wave pattern or notching on R or S waves in neighbouring 2 derivations (Figure 1). ECG recordings of patients died from all causes during hospital stay and patients discharged (without mortality) are compared according to presenc of fQRS.
In 91 patients (36.7%) included in our study fQRS was determined. Between groups of patients with fQRS and wihout fQRS there was no significant difference in MI localization (anterior Mİ: 38.5% vs 45.2%, p>0.05). In hospital mortality was found to be significantlu higher in patients with fQRS than in patients without it. (14.3% vs 4.5%, p=0.006) (Figure 2). Additionally when compared to patients without fQRS, patients with fQRS were found to have lower left ventricular ejection fraction (35±7% vs 47±6%; p<0.001), higher leukocyte counts (12.958±3.07 vs 10.780±3.38; p<0.001), higher maximum troponin levels (62.73±53.49 vs 29.71±16.17; p<0.001) and longer QRS durations (107.86±8.95 ms vs 102.77±9.21 ms; p<0.001) (Table 1).
In patients with acute STEMI fQRS presence on surface ECG is not related with MI localization whereas it is related with increased in hospital mortality. Also supporting this in acute STEMI patients presence of fQRS may help to determine high risk patients with larger infarct size.
|fQRS present (n=91)||fQRS absent (n=157)||p value|
|Hypertension (%)||48 (52,7)||72 (45,9)||0,296|
|Diabetes Mellitus (%)||21 (23,1)||29 (18,5)||0,384|
|Hyperlipidemia (%)||27 (29,7)||32 (20,4)||0,098|
|Cigarette habit (%)||55 (60,4)||92 (58,6)||0,776|
|Family history (%)||29 (31,9)||40 (25,5)||0,279|
|Chest pain duration (min)||194,62±174,01||165,19±171,51||0,196|
|Door to needle time (min)||29,11±9,43||26,90±8,08||0,181|
|Maximum CK-MB (ng/ml)||228,27±121,23||114,77±85,55||<0,001|
|Maximum Troponin (ng/ml)||62,73±53,49||29,71±16,17||<0,001|
|QRS duration (msn)||107,86±8,95||102,77±9,21||<0,001|
Anterior MI (%)
(SBP: systolic blood pressure, DBP: diastolic blood pressure, LVEF: left ventricular ejection fraction, HB: hemoglobin, WBC: white blood cell count, MPV: mean platelet volume, PLT: platelet count, BUN: blood urea nitrogen, LDL-chol: low density lipoprotein-cholesterol, HDL-chol: high density lipoprotein-cholesterol, CK-MB: creatinine kinase-muscle band, MI: myocardial infarction)