| Fragmented wide QRS on a 12-lead ECG: a sign of myocardial scar and poor prognosis. | |
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MedLine Citation:
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PMID: 19808417 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Fragmented QRS (duration <120 ms) on a 12-lead ECG represents myocardial scar in patients with coronary artery disease. However, the significance of fragmented QRS has not been defined in the presence of a wide QRS (wQRS; duration >or=120 ms). We postulate that fragmented wQRS (f-wQRS) due to bundle branch block, premature ventricular complexes, or paced rhythms (f-pQRS) signify myocardial scar and higher mortality. METHODS AND RESULTS: Patients who underwent cardiac evaluation with nuclear stress imaging or cardiac catheterization and had wQRS (bundle branch block, premature ventricular complex, or pQRS) were studied. f-wQRS was defined by the presence of >2 notches on the R wave or the S wave and had to be present in >or=2 contiguous inferior (II, III, aVF), lateral (I, aVL, V(6)) or anterior (V(1) to V(5)) leads. ECG analyses of 879 patients (age, 66.7+/-11.4 years; male, 97%; mean follow-up, 29+/-18 months) with bundle branch block (n=310), premature ventricular complex (n=301), and pQRS (n=268) revealed f-wQRS in 415 (47.2%) patients. Myocardial scar was present in 440 (50%) patients. The sensitivity, specificity, positive predictive value, and negative predictive value of f-wQRS for myocardial scar were 86.8%, 92.5%, 92.0%, and 87.5%, respectively. The sensitivity and specificity for diagnosing myocardial scar were 88.6% and 94.4%, 81.4% and 88.4%, and 89.8% and 95.7% for f-bundle branch block, f-premature ventricular complex, and f-pQRS, respectively. f-wQRS was associated with mortality after adjusting for age, ejection fraction, and diabetes (P=0.017). CONCLUSIONS: f-wQRS on a standard 12-lead ECG is a moderately sensitive and highly specific sign for myocardial scar in patients with known or suspected coronary artery disease. f-wQRS is also an independent predictor of mortality. |
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Authors:
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Mithilesh K Das; Hussam Suradi; Waddah Maskoun; Mark A Michael; Changyu Shen; Jonathan Peng; Gopi Dandamudi; Jo Mahenthiran |
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Publication Detail:
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Type: Comparative Study; Journal Article; Multicenter Study Date: 2008-07-14 |
Journal Detail:
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Title: Circulation. Arrhythmia and electrophysiology Volume: 1 ISSN: 1941-3084 ISO Abbreviation: Circ Arrhythm Electrophysiol Publication Date: 2008 Oct |
Date Detail:
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Created Date: 2009-10-07 Completed Date: 2009-10-27 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101474365 Medline TA: Circ Arrhythm Electrophysiol Country: United States |
Other Details:
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Languages: eng Pagination: 258-68 Citation Subset: IM |
Affiliation:
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Krannert Institute of Cardiology, Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, IN 46202, USA. midas@iupui.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Bundle-Branch Block / diagnosis, etiology*, physiopathology Cicatrix / complications*, physiopathology, radionuclide imaging Coronary Artery Disease / physiopathology*, radionuclide imaging Electrocardiography* Female Follow-Up Studies Humans Male Myocardium Prognosis Reproducibility of Results Retrospective Studies Time Factors Tomography, Emission-Computed, Single-Photon Ventricular Premature Complexes / diagnosis, etiology*, physiopathology |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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