Author + information
- Eser Açıkgöz1,
- Belma Yaman1,
- Sadık Kadri Açıkgöz2,
- Salih Topal1,
- Yusuf Tavil1 and
- Nuri Bülent Boyacı1
Fragmented QRS (fQRS) is accepted as a marker of myocardial scar caused by depolarisation defect. In recent studies, it was showed that fQRS is an indicator of ischemia and infarct. In ischemic cardiomyopathy, Brugada syndrome and arrhythmogenic right ventricular dysplasia, fQRS is predictor of arrhythmia attacks and mortality. In mitral stenosis fQRS is seen more frequent than healthy people and it is predictive of severe mitral stenosis, myocardial dysfunction and inreased pulmonary arterial pressure. The aim of our study is to assess the relationship between fQRS and severity of valve stenosis, left ventricular hypertrophy, decompanse diastolic heart failure and atrial fibrillation in aortic stenosis patients.
Meterial and Method
We evaluated aortic stenosis patients with the mean gradient over 20 mmHg in aortic valve. Patients with mitral stenosis, tricuspit stenosis, history of myocardial infarction, documented severe coronary arterial disease, nonischemic dilate cardiomyopathy, pacemaker ritm, electrolit disturbances and right or left bundle branch block were excluded. The study included 59 patients. For all patients12 leads ECG was recorded. Complete echocardiography performed, peak and mean transaortic systolic gradients, aortic jet velocity, septum and posterior wall thicknesses, diameter of ascendan aorta, left atrial size, ejection fraction and maksimum systolic pulmonary arterial pressure of patients were recorded. Electrocardiographies are assessed by two cardiologists unaware of the echocardiography results. Finally, patients divided into two groups as fQRS established group and others. Echocardiographic and clinical findings of the groups were compared.
The study included 59 patients. Mean age of the patients was 69±14,8 years. 27 subjects (45%) were men, 32 (55%) were women. fQRS was found in 44 (74%) subjects’ ECG. Age, gender, ejection fraction, septum and posterior wall thicknesses, left atrial size, aortic dimension, atrial fibrillation ratio and peak systolic transaortic gradients were similar in two groups. In fQRS group, median systolic transaortic gradient was significantly higher (median 35, interquartile range 20 vs. median 25, interquartile range 21, p=0.042). Decompansated diastolic heart failure ratio was 36.3% in fQRS group but only %6.6 in non-fQRS group (p= 0.025). Mean maximum systolic pulmonary arterial pressure was 43 mm Hg in fQRS group and 32 mm Hg in non-fQRS group (p=0.035).
In our study, 74% of aortic stenosis patients had fQRS in their ECGs. Aortic stenosis patients with fQRS had higher mean systolic transaortic gradients, higher ratio of decompansated heart failure and maximum systolic pulmonary arterial pressures than non- fQRS aortic stenosis patients.