Author + information
- Edgar Alexander Illescas González,
- Gabriela Melendez-Ramirez,
- Diego Araiza-Garaygordobil,
- Daniel Sierra-Lara,
- Agustin Rivera-Rodriguez,
- Aloha Meave and
- Erick Alexanderson Rosas
Background: Chagas’ disease is a serious public health problem. Sudden death due to ventricular arrhythmias associated with Chagas’ heart disease (ChHD) is common. QRS complex fragmentation (fQRS) increased risk of arrhythmia and sudden cardiac death. The purpose of our study was to evaluate the role of fQRS as a marker of ventricular tachycardia, myocardial fibrosis and left ventricular ejection fraction (LVEF) with cardiac Magnetic Resonance Imaging (MRI) in patients with Chagas disease.
Methods: Retrospectively single-center analysis the electrocardiograms of 47 patients with ChHD who underwent cardiac MRI between January 2009 and May 2016. Two blinded observers searched fQRS; a third observer reviewed in discordance. fQRS was defined as the RSR’ patterns and/or notching of the R/S wave with QRS duration < 120 ms or, in wide complexes, more than 2 R waves (R'), more than 2 notches in the R or S wave, in at least 2 contiguous leads. Fragmentation was classified into anterior (V1- V5), lateral (I, aVL, and V6), or inferior (II, III, and aVF).
Results: There were 29 patients (61.7%) with fQRS. Those with fQRS had lower LVEF (31.6±16.7 vs. 46.3±17.2, p = 0.006). Electrocardiographic location was anterior in 17.2%, inferior in 79.3% and lateral in 37.9%; fragmentation in multiple territories (> 2) was found in 9 patients (31.0%). One presented fragmentation in all 3 anatomic territories. Lateral fQRS was present in 34.5% with any documented ventricular tachycardia, compared to 5.5% of those who didn't show any form of ventricular tachycardia (p=0.03, Se 34%, Sp 94%). Twenty nine percent of the patients with any degree of late gadolinium enhancement (LGE) showed fQRS. No patient without LGE showed fQRS (p = 0.08). Among the patients with lateral fQRS, 90% showed transmural or intramyocardial LGE in lateral segments, compared to 52% (19/36) of those without lateral fQRS (p = 0.03, Se 90%, Sp 52.8%).
Conclusions: In patients with ChHD, fQRS is a potential electrocardiographic marker of fibrosis, left ventricular dysfunction on MRI and ventricular tachycardia, especially when found in the lateral territory
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Non Invasive Imaging: MR Structure and Valuvular Heart Disease
Abstract Category: 29. Non Invasive Imaging: MR
Presentation Number: 1290-212
- 2017 American College of Cardiology Foundation