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Observational Study
. 2023 Jan;36(1):43-52.
doi: 10.1111/sdi.13055. Epub 2022 Jan 25.

Fragmented QRS complex on a 12-lead electrocardiogram predicts cardiovascular and all-cause mortality in dialysis patients

Xinjian Li  1 , Bingshuo Shi  1 , Xu Chen  1 , Junying Duan  1 , Xing Liu  1 , Ruining Zhang  2 , Guangping Li  1
Affiliations
Observational Study

Fragmented QRS complex on a 12-lead electrocardiogram predicts cardiovascular and all-cause mortality in dialysis patients

Xinjian Li et al. Semin Dial. 2023 Jan.

Abstract

Background: Cardiovascular disease (CVD) is the most common cause of mortality in end-stage renal disease (ESRD) patients. Fragmented QRS complex (fQRS) has been reported as a helpful marker in evaluating various cardiovascular pathologies. We aimed to investigate the value of the fQRS complex clinical decision of ESRD patients receiving dialysis.

Methods: This prospective observational study included 411 patients receiving hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD) between 2016-01-01 and 2020-12-31. The primary outcomes were all-cause and cardiovascular (CV) mortality.

Results: HD patients have elevated values of fQRS complex compared to CAPD patients (39.1% vs. 28.2%, P = 0.027). Significantly, fQRS complex in the anterior/lateral leads is associated with all-cause and CV mortality stronger than fQRS in the inferior leads (P = 0.008). In a multivariate Cox regression analysis, HD patients with fQRS complex had a higher incidence of all-cause mortality (hazard ratio [HR] = 1.860; 95% confidence interval [CI]: [1.032, 3.349]; p = 0.041) and CV mortality (HR = 2.989; 95% CI [1.357, 6.584]; p = 0.007). For CAPD patients, fQRS complex was also associated with increased risk of all-cause mortality (HR = 1.593; 95% CI [1.023, 2.580]; p = 0.049) and increased risk of CV mortality (HR = 2.392; 95% CI [1.348, 4.173]; p = 0.013).

Conclusions: The presence of the fQRS complex was an independent predictor of all-cause and CV mortality in HD and CAPD patients. We suggested a potential role of the fQRS complex in CV risk strata for dialysis patients and the choice of dialysis modality.

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References

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