Document Detail


Fragmented QRS in prediction of cardiac deaths and heart failure hospitalizations after myocardial infarction.
MedLine Citation:
PMID:  20522053     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Increased QRS fragmentation in visual inspection of 12-lead ECG has shown association with cardiac events in postmyocardial infarction (MI) patients. We investigated user-independent computerized intra-QRS fragmentation analysis in prediction of cardiac deaths and heart failure (HF) hospitalizations after MI. METHODS: Patients (n = 158) with recent MI and reduced left ventricular ejection fraction (LVEF) were studied. A 120-lead body surface potential mapping was performed at hospital discharge. Intra-QRS fragmentation was computed as the number of extrema (fragmentation index FI) in QRS. QRS duration (QRSd) was computed for comparison. RESULTS: During a mean follow-up of 50 months 15 patients suffered cardiac death and 23 were hospitalized for HF. Using the mean + 1 SD as cut-point both parameters were univariate predictors of both end-points. In multivariate analysis including age, gender, LVEF, previous MI, bundle branch block, atrial fibrillation, and diabetes FI was an independent predictor for cardiac deaths (HR 8.7, CI 3.0-25.6) and HF hospitalizations (HR 3.8, CI 1.6-9.3) whereas QRSd only predicted HF hospitalizations (HR 4.6, CI 2.0-10.7). In comparison to QRSd, FI showed better positive (PPA) and equal negative (NPA) predictive accuracy for both end-points, and PPA was further improved when combined to LVEF < 40%. Limiting fragmentation analysis to 12-lead ECG or a randomly selected 8-lead set instead of all 120 leads resulted in an almost similar prediction. CONCLUSIONS: Increased QRS fragmentation in post-MI patients predicts cardiac deaths and HF progression. A computer-based fragmentation analysis is a stronger predictor than QRSd.
Authors:
Petri Korhonen; Terhi Husa; Teijo Konttila; Ilkka Tierala; Markku Mäkijärvi; Heikki Väänänen; Janne Ojanen; Aki Vehtari; Lauri Toivonen
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc     Volume:  15     ISSN:  1542-474X     ISO Abbreviation:  Ann Noninvasive Electrocardiol     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-06-04     Completed Date:  2010-10-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9607443     Medline TA:  Ann Noninvasive Electrocardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  130-7     Citation Subset:  IM    
Affiliation:
Helsinki University Hospital, Finland. petri.korhonen@hus.fi <petri.korhonen@hus.fi>
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MeSH Terms
Descriptor/Qualifier:
Death*
Electrocardiography / methods*
Female
Follow-Up Studies
Heart Failure / complications,  diagnosis*
Hospitalization / statistics & numerical data*
Humans
Kaplan-Meiers Estimate
Male
Middle Aged
Myocardial Infarction / complications*
Predictive Value of Tests
Prospective Studies
ROC Curve
Reproducibility of Results
Risk Factors
Signal Processing, Computer-Assisted

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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