Author + information
- Adem Adar1,
- Abdulkadir Kırış2,
- Yılmaz Bülbül2,
- Hüseyin Bektaş3,
- Sercan Okutucu1,
- Murat Acat1,
- Hasan Casim1,
- Hakan Orhan Elönü1 and
- Tayyar Gökdeniz4
Presence of Fragmented QRS and Its Relationship with Cardiac Functions in Patients with Obstructive Sleep Apnea
Obstructive Sleep Apnea (OSA) is associated with left ventricular dysfunction because of myocardial inflammation and fibrosis. Fragmented QRS (fQRS) has also been associated with myocardial fibrosis and heart failure. The value of fQRS as an indicator of myocardial fibrosis and heart failure in patents with OSA has unknown.
In this study, we aimed to assess the relationship between OSA and fQRS with cardiac function.
One hundred eighty eight patients underwent an overnight polysomnography were enrolled in the study. Thirty five patients were excluded from study according to exclusion criteria. Patients divided into two groups; group 1 had OSA and group 2 had not. FQRS was defined to be notching in R or S wave, the presence of additional R wave (R’) or fragmented R wave (more than one R’) at least two consecutive derivation of 12 lead electrocardiograms. Left and right cardiac functions were assessed by myocardial performance index (Tei index) and tricuspid annular plane systolic excursion (Tapse), respectively. Multivariable regression analysis was performed to assess the independent relationship between fQRS and cardiac function in patients with OSA.
Group 1 consisted of 121 patients (mean age 50.5±10) with OSA (26 mild, 31 moderate, 64 severe) and group 2 included 32 non-OSA patients (mean age 45.34±9). Baseline demographic features were similar such as gender (p=0.71), presence of hypertension (p=0.47), presence of diabetes (p=0.51), the usage of b-blocker (p=0.91), the usage of ACE inhibitor (p=0.53) and the body mass index (p=0.11). FQRS was detected in 85 (70%) of OSA patients and 4 (12.5%) of non-OSA. Left cardiac functions were impaired in patients with OSA than non-OSA assessed by tei index (0.61±32 vs 0.43.02 p=0.001) but right cardiac function assessed by tapse was not impaired (24.13±2.6 vs 23.7±2.6, p=0.56). Also, in OSA group, patients with fQRS had impaired left cardiac functions assessed by tei index (p<0.001) than without fQRS but right cardiac function assessed by tapse was not impaired (p=0.792) than those without fQRS. In multivariable logistic analyze, left ventricular Tei index (p<0.001), lowest nocturnal oxygen saturation (p=0.018) and left ventricular mass index (p=0.003) were independently associated with fQRS in patients with OSA.
Patients with OSA have frequent fQRS than those without OSA. Severity of OSA is also associated with fQRS formation. FQRS is related with impaired left ventricular function in this population.
|Gender (male/female)||58/ 27||22/14||0.53|
|Hypertension, n(%)||30 (65.2%)||16 (34.8%)||0.41|
|Diabetes Mellitus, n(%)||10(58.8%)||7(41.2%)||0.26|
|Body mass index (kg/m2)||33.89±16||31.52±5.9||0.39|
|Apnea-hypopnea index (events/hour)||37.79±28.14||25.51±21.14||0.004|
|Lowest nocturnal oxygen saturation (%)||66.91±27.56||78.86±21.14||0.025|
|Length of time SpO2<90% (minute)||41.67±59.6||16.2±40||0.021|
|ACE inhibitor n(%)||21(58.3%)||15(41.7%)||0.08|
ACE: angiotensin converting enzyme
|LVEDD (mm)||48.26 ±3.7||44.7±3.17||0<0.001|
|IVS (mm)||10.70 ±1.06||10.31 ±1||0.066|
|PW (mm)||10.60 ±1.06||10 ± 1||0.003|
|LV MASSINDEX (kg/m2)||92.42±18.76||77.52±13.43||0<0.001|
|LA (mm)||38.67 ±3.17||35.8 ±3||0<0.001|
|E (m/s)||66.3±13.02||76 ±15.33||0.007|
|Tei index||0.69 ±0.24||0.42 ±0.12||<0.001|
A: late diastolic mitral inflow; A’: late diastolic mitral annular velocity; E: early diastolic mitral inflow; E’: early diastolic mitral annular velocity; EF: ejection fraction; IVS: interventricular septum; LA: left atrium; LV: left ventricle; LVEDD: left ventricular end-diastolic diameter; LVESD: left ventricular end-systolic diameter; EF: Ejection Fraction; PW: posterior wall; S: peak systolic mitral annular velocity; TAPSE: tricuspid annular plane systolic excursion. RAD: right atrial minör dimension,RVD: right ventricular mid cavity diameter
|Lowest nocturnal oxygen saturation||-0.374||<0.001||0.970||(0.946-0.995)||0.018|
|Length of time SpO2<90%||0.339||<0.001||1.009||(0.991-1.027)||0.344|
|Lv mass ındex||0.400||<0.001||1.087||(1.029-1.148)||0.003|
Lv mass ındex: Left Ventricular Mass Index, EF: Ejection Fraction