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Comparative Study
. 2009 Sep;25(9):517-22.
doi: 10.1016/s0828-282x(09)70137-0.

The utility of fragmented QRS complexes to predict significant intraventricular dyssynchrony in nonischemic dilated cardiomyopathy patients with a narrow QRS interval

Kursat Tigen  1 , Tansu Karaahmet, Emre Gurel, Cihan Cevik, Kenneth Nugent, Selcuk Pala, Ali Cevat Tanalp, Bulent Mutlu, Yelda Basaran
Affiliations
Comparative Study

The utility of fragmented QRS complexes to predict significant intraventricular dyssynchrony in nonischemic dilated cardiomyopathy patients with a narrow QRS interval

Kursat Tigen et al. Can J Cardiol. 2009 Sep.

Abstract
in English, French

Background: Fragmented QRS complexes in the electrocardiograms (ECGs) of patients with coronary artery disease are associated with adverse cardiac events. However, there are limited data on its predictive usefulness in patients with nonischemic dilated cardiomyopathy. Left ventricular dyssynchrony is common in heart failure patients who have wide QRS intervals, but its frequency in patients with narrow QRS intervals is uncertain.

Objectives: To investigate the relationship between fragmented QRS complexes and intraventricular dyssynchrony in patients with nonischemic dilated cardiomyopathy in sinus rhythm.

Methods: Sixty nonischemic dilated cardiomyopathy patients with sinus rhythm and narrow QRS intervals were recruited. Forty patients had a fragmented QRS in their basal ECG, and 20 patients did not have a fragmented QRS. Patients were analyzed for correlation between fragmented QRS complexes and intraventricular dyssynchrony.

Results: The maximal difference in time to the peak myocardial systolic velocity between any two left ventricular segments (Max-ASE Sys), and maximal difference between Max-ASE Sys and the mean value of all segments (Max-ASE to Mean Sys) were significantly higher in patients with fragmented QRS complexes (P=0.001 and P=0.003, respectively). Seventy-two per cent of the patients with fragmented QRS complexes had significant left ventricular dyssynchrony; 15% of patients without fragmented QRS complexes had significant left ventricular dyssynchrony (P<0.0001). The presence of fragmented QRS complexes in leads corresponding to the specific ventricular segment in basal ECG was found to detect intraventricular dyssynchrony with 90.6% sensitivity (negative predictive value of 85%).

Conclusion: Fragmentation in the resting ECG is associated with significant intraventricular dyssynchrony in patients with nonischemic cardiomyopathy, narrow QRS and sinus rhythm. Fragmentation in ECG might be useful in identifying patients who could benefit from cardiac resynchronization therapy.

HISTORIQUE :: Chez les patients souffrant de coronaropathie, on associe les complexes QRS fragmentés à l’électrocardiogramme (ÉCG) à des complications cardiaques. Or, on manque de données sur son utilité prédictive chez les patients qui souffrent de cardiomyopathie dilatée non ischémique. La dyssynchronie ventriculaire gauche s’observe fréquemment chez les insuffisants cardiaques qui présentent des QRS élargis, mais sa fréquence chez les patients dont les QRS sont étroits est mal connue.

OBJECTIF :: Analyser le lien entre les QRS fragmentés et la dyssynchronie intraventriculaire chez des patients souffrant de cardiomyopathie dilatée non ischémique dont le rythme est sinusal.

MÉTHODE :: Les auteurs ont recruté 60 patients atteints de cardiomyopathie dilatée non ischémique présentant un rythme sinusal et des QRS étroits. À l’ÉCG de base, 40 patients présentaient des QRS fragmentés et 20 patients, des QRS non fragmentés. On a soumis les patients à une analyse de corrélation entre les complexes QRS fragmentés et la dyssynchronie intraventriculaire.

RÉSULTATS :: La différence maximale pour ce qui est du temps d’atteinte du pic systolique de vélocité (Vmax) myocardique entre n’importe quelle paire de segments ventriculaires gauches et la différence maximale entre ce Vmax et la valeur moyenne de tous les segments (Vmax:moyenne des segments) ont été significativement plus marquées chez les patients qui avaient des complexes QRS fragmentés (p = 0,001 et p = 0,003, respectivement). Soixante-douze pour cent des patients dont les QRS étaient fragmentés présentaient une dyssynchronie ventriculaire gauche significative, contre 15 % des patients dont les QRS n’étaient pas fragmentés (p < 0,0001). La présence de QRS fragmentés aux dérivations correspondant aux segments ventriculaires spécifiques à l’ÉCG de base s’est révélée prédictive d’une dyssynchronie intraventriculaire avec une sensibilité de 90,6 % (valeur prédictive négative de 85 %).

CONCLUSION :: La fragmentation des QRS à l’ÉCG au repos est associée à une dyssynchronie intraventriculaire significative chez les patients souffrant de cardiomyopathie non ischémique en présence de QRS étroits et de rythme sinusal. La fragmentation à l’ÉCG pourrait servir à reconnaître les patients susceptibles de bénéficier d’un traitement de resynchronisation cardiaque.

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Figures

Figure 1)
Figure 1)
The fragmented QRS (fQRS) on a 12-lead electrocardiogram is defined as the presence of slurred QRS complexes with various RSR′ patterns (≥1 R′ or notching of S wave or R wave) without typical bundle branch block in two contiguous leads corresponding to a major coronary artery territory
Figure 2)
Figure 2)
Demonstration of the time from the onset of QRS to peak myocardial systolic velocity (Ts) calculation
Figure 3)
Figure 3)
Intraventricular dyssynchrony in a patient with fragmented QRS (left) and in a patient with a normal QRS complex (right)
Figure 4)
Figure 4)
Number of dyssynchronic and nondyssynchronic patients within the normal or fragmented QRS group
See this image and copyright information in PMC

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