Document Detail

Fragmented QRS on a 12-lead ECG: a predictor of mortality and cardiac events in patients with coronary artery disease.
MedLine Citation:
PMID:  17954396     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Fragmented QRS (fQRS) on a 12-lead electrocardiogram (ECG) is associated with myocardial scar in patients with coronary artery disease (CAD). OBJECTIVE: We postulated that fQRS is a predictor of cardiac events and mortality in patients who have known CAD or who are being evaluated for CAD. METHODS: The cardiac events (myocardial infarction, need for revascularization, or cardiac death) and all-cause mortality were retrospectively reviewed in 998 patients (mean age 65.5 +/- 11.9 years, male 967) who underwent nuclear stress test. The fQRS on a 12-lead ECG included various RSR' patterns (> or =1 R' prime or notching of S wave or R wave) without typical bundle branch block in 2 contiguous leads corresponding to a major coronary artery territory. RESULTS: All-cause mortality (93 [34.1%] vs 188 [25.9%]) and cardiac event rate (135 [49.5%] vs 200 [27.6%]) were higher in the fQRS group compared with the non-fQRS group during a mean follow-up of 57 +/- 23 months. A Kaplan-Meier survival analysis revealed significantly lower event-free survival for cardiac events (P <.001) and all-cause mortality (P = .02). Multivariate Cox regression analysis revealed that significant fQRS was an independent significant predictor for cardiac events but not for all-cause mortality. The Kaplan-Meier survival analysis showed no significant difference between fQRS and Q waves groups for cardiac events (P = .48) and all-cause mortality (P = .08). CONCLUSION: The fQRS is an independent predictor of cardiac events in patients with CAD. It is associated with significantly lower event-free survival for a cardiac event on long-term follow-up.
Mithilesh Kumar Das; Chandan Saha; Hicham El Masry; Jonathan Peng; Gopi Dandamudi; Jo Mahenthiran; Paul McHenry; Douglas P Zipes
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Publication Detail:
Type:  Journal Article     Date:  2007-08-01
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  4     ISSN:  1547-5271     ISO Abbreviation:  Heart Rhythm     Publication Date:  2007 Nov 
Date Detail:
Created Date:  2007-10-23     Completed Date:  2008-02-08     Revised Date:  2009-10-27    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1385-92     Citation Subset:  IM    
Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
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MeSH Terms
Coronary Artery Disease / diagnosis*,  mortality
Exercise Test
Retrospective Studies
Risk Factors
Stroke Volume
Tomography, Emission-Computed, Single-Photon
Comment In:
Heart Rhythm. 2007 Nov;4(11):1393-4   [PMID:  17954397 ]

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