Fragmented QRS on a 12-lead ECG: A predictor of mortality and cardiac events in patients with coronary artery disease

Mithilesh Das, Chandan Saha, Hicham El Masry, Jonathan Peng, Gopi Dandamudi, Jo Mahenthiran, Paul McHenry, Douglas P. Zipes

Research output: Contribution to journalArticle

208 Citations (Scopus)

Abstract

Background: Fragmented QRS (fQRS) on a 12-lead electrocardiogram (ECG) is associated with myocardial scar in patients with coronary artery disease (CAD). Objective: We postulated that fQRS is a predictor of cardiac events and mortality in patients who have known CAD or who are being evaluated for CAD. Methods: The cardiac events (myocardial infarction, need for revascularization, or cardiac death) and all-cause mortality were retrospectively reviewed in 998 patients (mean age 65.5 ± 11.9 years, male 967) who underwent nuclear stress test. The fQRS on a 12-lead ECG included various RSR′ patterns (≥1 R′ prime or notching of S wave or R wave) without typical bundle branch block in 2 contiguous leads corresponding to a major coronary artery territory. Results: All-cause mortality (93 [34.1%] vs 188 [25.9%]) and cardiac event rate (135 [49.5%] vs 200 [27.6%]) were higher in the fQRS group compared with the non-fQRS group during a mean follow-up of 57 ± 23 months. A Kaplan-Meier survival analysis revealed significantly lower event-free survival for cardiac events (P <.001) and all-cause mortality (P = .02). Multivariate Cox regression analysis revealed that significant fQRS was an independent significant predictor for cardiac events but not for all-cause mortality. The Kaplan-Meier survival analysis showed no significant difference between fQRS and Q waves groups for cardiac events (P = .48) and all-cause mortality (P = .08). Conclusion: The fQRS is an independent predictor of cardiac events in patients with CAD. It is associated with significantly lower event-free survival for a cardiac event on long-term follow-up.

Original languageEnglish
Pages (from-to)1385-1392
Number of pages8
JournalHeart Rhythm
Volume4
Issue number11
DOIs
StatePublished - Nov 2007

Fingerprint

Coronary Artery Disease
Electrocardiography
Mortality
Kaplan-Meier Estimate
Survival Analysis
Disease-Free Survival
Bundle-Branch Block
Exercise Test
Cicatrix
Lead
Coronary Vessels
Myocardial Infarction
Regression Analysis

Keywords

  • Cardiac events
  • Fragmented QRS
  • Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Fragmented QRS on a 12-lead ECG : A predictor of mortality and cardiac events in patients with coronary artery disease. / Das, Mithilesh; Saha, Chandan; El Masry, Hicham; Peng, Jonathan; Dandamudi, Gopi; Mahenthiran, Jo; McHenry, Paul; Zipes, Douglas P.

In: Heart Rhythm, Vol. 4, No. 11, 11.2007, p. 1385-1392.

Research output: Contribution to journalArticle

Das, Mithilesh ; Saha, Chandan ; El Masry, Hicham ; Peng, Jonathan ; Dandamudi, Gopi ; Mahenthiran, Jo ; McHenry, Paul ; Zipes, Douglas P. / Fragmented QRS on a 12-lead ECG : A predictor of mortality and cardiac events in patients with coronary artery disease. In: Heart Rhythm. 2007 ; Vol. 4, No. 11. pp. 1385-1392.
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abstract = "Background: Fragmented QRS (fQRS) on a 12-lead electrocardiogram (ECG) is associated with myocardial scar in patients with coronary artery disease (CAD). Objective: We postulated that fQRS is a predictor of cardiac events and mortality in patients who have known CAD or who are being evaluated for CAD. Methods: The cardiac events (myocardial infarction, need for revascularization, or cardiac death) and all-cause mortality were retrospectively reviewed in 998 patients (mean age 65.5 ± 11.9 years, male 967) who underwent nuclear stress test. The fQRS on a 12-lead ECG included various RSR′ patterns (≥1 R′ prime or notching of S wave or R wave) without typical bundle branch block in 2 contiguous leads corresponding to a major coronary artery territory. Results: All-cause mortality (93 [34.1{\%}] vs 188 [25.9{\%}]) and cardiac event rate (135 [49.5{\%}] vs 200 [27.6{\%}]) were higher in the fQRS group compared with the non-fQRS group during a mean follow-up of 57 ± 23 months. A Kaplan-Meier survival analysis revealed significantly lower event-free survival for cardiac events (P <.001) and all-cause mortality (P = .02). Multivariate Cox regression analysis revealed that significant fQRS was an independent significant predictor for cardiac events but not for all-cause mortality. The Kaplan-Meier survival analysis showed no significant difference between fQRS and Q waves groups for cardiac events (P = .48) and all-cause mortality (P = .08). Conclusion: The fQRS is an independent predictor of cardiac events in patients with CAD. It is associated with significantly lower event-free survival for a cardiac event on long-term follow-up.",
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T2 - A predictor of mortality and cardiac events in patients with coronary artery disease

AU - Das, Mithilesh

AU - Saha, Chandan

AU - El Masry, Hicham

AU - Peng, Jonathan

AU - Dandamudi, Gopi

AU - Mahenthiran, Jo

AU - McHenry, Paul

AU - Zipes, Douglas P.

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N2 - Background: Fragmented QRS (fQRS) on a 12-lead electrocardiogram (ECG) is associated with myocardial scar in patients with coronary artery disease (CAD). Objective: We postulated that fQRS is a predictor of cardiac events and mortality in patients who have known CAD or who are being evaluated for CAD. Methods: The cardiac events (myocardial infarction, need for revascularization, or cardiac death) and all-cause mortality were retrospectively reviewed in 998 patients (mean age 65.5 ± 11.9 years, male 967) who underwent nuclear stress test. The fQRS on a 12-lead ECG included various RSR′ patterns (≥1 R′ prime or notching of S wave or R wave) without typical bundle branch block in 2 contiguous leads corresponding to a major coronary artery territory. Results: All-cause mortality (93 [34.1%] vs 188 [25.9%]) and cardiac event rate (135 [49.5%] vs 200 [27.6%]) were higher in the fQRS group compared with the non-fQRS group during a mean follow-up of 57 ± 23 months. A Kaplan-Meier survival analysis revealed significantly lower event-free survival for cardiac events (P <.001) and all-cause mortality (P = .02). Multivariate Cox regression analysis revealed that significant fQRS was an independent significant predictor for cardiac events but not for all-cause mortality. The Kaplan-Meier survival analysis showed no significant difference between fQRS and Q waves groups for cardiac events (P = .48) and all-cause mortality (P = .08). Conclusion: The fQRS is an independent predictor of cardiac events in patients with CAD. It is associated with significantly lower event-free survival for a cardiac event on long-term follow-up.

AB - Background: Fragmented QRS (fQRS) on a 12-lead electrocardiogram (ECG) is associated with myocardial scar in patients with coronary artery disease (CAD). Objective: We postulated that fQRS is a predictor of cardiac events and mortality in patients who have known CAD or who are being evaluated for CAD. Methods: The cardiac events (myocardial infarction, need for revascularization, or cardiac death) and all-cause mortality were retrospectively reviewed in 998 patients (mean age 65.5 ± 11.9 years, male 967) who underwent nuclear stress test. The fQRS on a 12-lead ECG included various RSR′ patterns (≥1 R′ prime or notching of S wave or R wave) without typical bundle branch block in 2 contiguous leads corresponding to a major coronary artery territory. Results: All-cause mortality (93 [34.1%] vs 188 [25.9%]) and cardiac event rate (135 [49.5%] vs 200 [27.6%]) were higher in the fQRS group compared with the non-fQRS group during a mean follow-up of 57 ± 23 months. A Kaplan-Meier survival analysis revealed significantly lower event-free survival for cardiac events (P <.001) and all-cause mortality (P = .02). Multivariate Cox regression analysis revealed that significant fQRS was an independent significant predictor for cardiac events but not for all-cause mortality. The Kaplan-Meier survival analysis showed no significant difference between fQRS and Q waves groups for cardiac events (P = .48) and all-cause mortality (P = .08). Conclusion: The fQRS is an independent predictor of cardiac events in patients with CAD. It is associated with significantly lower event-free survival for a cardiac event on long-term follow-up.

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KW - Mortality

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