Fragmented left sided QRS in absence of bundle branch block

Sign of left ventricular aneurysm

Chatla V R Reddy, Kuruvilla Cheriparambill, Barry Saul, Majesh Makan, John Kassotis, Awaneesh Kumar, Mithilesh Das

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Background: A left ventricular aneurysm (LVA) occurs between 3.5% and 9.4% of all cases of acute myocardial infarction. A fragmented left sided QRS (RSR̀ pattern or its variant RSr̀, rSR̀, or rSr̀) without evidence of bundle branch block (QRS duration ≤120 ms) on the ECG may be associated with a significant myocardial scar, which is the characteristic of a LVA. We, therefore, postulate that fragmented QRS (RSR̀ pattern or its variant) in the left sided leads (I, aVL, V3 to V6) may be a useful sign of LVA. Methods: ECGs of 110 consecutive patients with LVA documented by left ventricular angiography (30°right anterior oblique view) was compared with 220 patients without LVA (110 patients with and 110 patients without coronary artery disease (CAD)), who were evaluated for CAD by symptoms and signs. Results: The sensitivity of the fragmented QRS for identification of LVA was 50% (55 of 110 patients) and specificity was 94.6% (209 of 220). Within the study population, the positive predictive value of the fragmented QRS for LVA was 83.3% (55 of 66) and the negative predictive value was 79.2% (209 of 264). Based on the range of prevalence of LVA in postmyocardial infarction population (3.5-9.4%) and on observed sensitivity and specificity, the positive predictive value of fragmented QRS for LVA after infarction can be estimated at 29-53% and the negative predictive value can be estimated at 95-98%. Conclusion: The sensitivity of fragmented QRS in left precordial leads for LVA was only 50%, whereas the specificity was 94.5%. It has a relatively low to moderate positive predictive value and high negative predictive value.

Original languageEnglish
Pages (from-to)132-138
Number of pages7
JournalAnnals of Noninvasive Electrocardiology
Volume11
Issue number2
DOIs
StatePublished - Apr 2006

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Bundle-Branch Block
Aneurysm
Infarction
Coronary Artery Disease
Electrocardiography
Population
Signs and Symptoms
Cicatrix
Angiography
Myocardial Infarction
Sensitivity and Specificity

Keywords

  • Fragmented QRS
  • Left ventricular aneurysm

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Fragmented left sided QRS in absence of bundle branch block : Sign of left ventricular aneurysm. / Reddy, Chatla V R; Cheriparambill, Kuruvilla; Saul, Barry; Makan, Majesh; Kassotis, John; Kumar, Awaneesh; Das, Mithilesh.

In: Annals of Noninvasive Electrocardiology, Vol. 11, No. 2, 04.2006, p. 132-138.

Research output: Contribution to journalArticle

Reddy, Chatla V R ; Cheriparambill, Kuruvilla ; Saul, Barry ; Makan, Majesh ; Kassotis, John ; Kumar, Awaneesh ; Das, Mithilesh. / Fragmented left sided QRS in absence of bundle branch block : Sign of left ventricular aneurysm. In: Annals of Noninvasive Electrocardiology. 2006 ; Vol. 11, No. 2. pp. 132-138.
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abstract = "Background: A left ventricular aneurysm (LVA) occurs between 3.5{\%} and 9.4{\%} of all cases of acute myocardial infarction. A fragmented left sided QRS (RSR̀ pattern or its variant RSr̀, rSR̀, or rSr̀) without evidence of bundle branch block (QRS duration ≤120 ms) on the ECG may be associated with a significant myocardial scar, which is the characteristic of a LVA. We, therefore, postulate that fragmented QRS (RSR̀ pattern or its variant) in the left sided leads (I, aVL, V3 to V6) may be a useful sign of LVA. Methods: ECGs of 110 consecutive patients with LVA documented by left ventricular angiography (30°right anterior oblique view) was compared with 220 patients without LVA (110 patients with and 110 patients without coronary artery disease (CAD)), who were evaluated for CAD by symptoms and signs. Results: The sensitivity of the fragmented QRS for identification of LVA was 50{\%} (55 of 110 patients) and specificity was 94.6{\%} (209 of 220). Within the study population, the positive predictive value of the fragmented QRS for LVA was 83.3{\%} (55 of 66) and the negative predictive value was 79.2{\%} (209 of 264). Based on the range of prevalence of LVA in postmyocardial infarction population (3.5-9.4{\%}) and on observed sensitivity and specificity, the positive predictive value of fragmented QRS for LVA after infarction can be estimated at 29-53{\%} and the negative predictive value can be estimated at 95-98{\%}. Conclusion: The sensitivity of fragmented QRS in left precordial leads for LVA was only 50{\%}, whereas the specificity was 94.5{\%}. It has a relatively low to moderate positive predictive value and high negative predictive value.",
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T1 - Fragmented left sided QRS in absence of bundle branch block

T2 - Sign of left ventricular aneurysm

AU - Reddy, Chatla V R

AU - Cheriparambill, Kuruvilla

AU - Saul, Barry

AU - Makan, Majesh

AU - Kassotis, John

AU - Kumar, Awaneesh

AU - Das, Mithilesh

PY - 2006/4

Y1 - 2006/4

N2 - Background: A left ventricular aneurysm (LVA) occurs between 3.5% and 9.4% of all cases of acute myocardial infarction. A fragmented left sided QRS (RSR̀ pattern or its variant RSr̀, rSR̀, or rSr̀) without evidence of bundle branch block (QRS duration ≤120 ms) on the ECG may be associated with a significant myocardial scar, which is the characteristic of a LVA. We, therefore, postulate that fragmented QRS (RSR̀ pattern or its variant) in the left sided leads (I, aVL, V3 to V6) may be a useful sign of LVA. Methods: ECGs of 110 consecutive patients with LVA documented by left ventricular angiography (30°right anterior oblique view) was compared with 220 patients without LVA (110 patients with and 110 patients without coronary artery disease (CAD)), who were evaluated for CAD by symptoms and signs. Results: The sensitivity of the fragmented QRS for identification of LVA was 50% (55 of 110 patients) and specificity was 94.6% (209 of 220). Within the study population, the positive predictive value of the fragmented QRS for LVA was 83.3% (55 of 66) and the negative predictive value was 79.2% (209 of 264). Based on the range of prevalence of LVA in postmyocardial infarction population (3.5-9.4%) and on observed sensitivity and specificity, the positive predictive value of fragmented QRS for LVA after infarction can be estimated at 29-53% and the negative predictive value can be estimated at 95-98%. Conclusion: The sensitivity of fragmented QRS in left precordial leads for LVA was only 50%, whereas the specificity was 94.5%. It has a relatively low to moderate positive predictive value and high negative predictive value.

AB - Background: A left ventricular aneurysm (LVA) occurs between 3.5% and 9.4% of all cases of acute myocardial infarction. A fragmented left sided QRS (RSR̀ pattern or its variant RSr̀, rSR̀, or rSr̀) without evidence of bundle branch block (QRS duration ≤120 ms) on the ECG may be associated with a significant myocardial scar, which is the characteristic of a LVA. We, therefore, postulate that fragmented QRS (RSR̀ pattern or its variant) in the left sided leads (I, aVL, V3 to V6) may be a useful sign of LVA. Methods: ECGs of 110 consecutive patients with LVA documented by left ventricular angiography (30°right anterior oblique view) was compared with 220 patients without LVA (110 patients with and 110 patients without coronary artery disease (CAD)), who were evaluated for CAD by symptoms and signs. Results: The sensitivity of the fragmented QRS for identification of LVA was 50% (55 of 110 patients) and specificity was 94.6% (209 of 220). Within the study population, the positive predictive value of the fragmented QRS for LVA was 83.3% (55 of 66) and the negative predictive value was 79.2% (209 of 264). Based on the range of prevalence of LVA in postmyocardial infarction population (3.5-9.4%) and on observed sensitivity and specificity, the positive predictive value of fragmented QRS for LVA after infarction can be estimated at 29-53% and the negative predictive value can be estimated at 95-98%. Conclusion: The sensitivity of fragmented QRS in left precordial leads for LVA was only 50%, whereas the specificity was 94.5%. It has a relatively low to moderate positive predictive value and high negative predictive value.

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