DOI QR코드

DOI QR Code

Absence and Resolution of Fragmented QRS Predict Reversible Myocardial Ischemia With Higher Probability of ST Segment Resolution in Patients With ST Segment Elevation Myocardial Infarction

  • Cetin, Mustafa (Department of Cardiology, Rize Education and Research Hospital) ;
  • Kocaman, Sinan Altan (Department of Cardiology, Rize Education and Research Hospital) ;
  • Kiris, Tuncay (Department of Cardiology, Ordu State Hospital) ;
  • Erdogan, Turan (Department of Cardiology, Rize University, Faculty of Medicine) ;
  • Canga, Aytun (Department of Cardiology, Rize Education and Research Hospital) ;
  • Durakoglugil, Murtaza Emre (Department of Cardiology, Rize University, Faculty of Medicine) ;
  • Cicek, Yuksel (Department of Cardiology, Rize University, Faculty of Medicine) ;
  • Dogan, Sitki (Department of Cardiology, Rize Education and Research Hospital) ;
  • Satiroglu, Omer (Department of Cardiology, Rize University, Faculty of Medicine)
  • 발행 : 2012.10.31

초록

Background and Objectives: Fragmented QRS complexes (fQRS) are associated with increased morbidity and mortality. The causative relationship between fQRS and cardiac fibrosis has been shown, but whether the presence and the number of fQRS on admission of electrocardiogram (ECG) predicts ST segment resolution in patients undergoing primary percutaneous coronary intervention (p-PCI) has not been investigated until now. Subjects and Methods: This study included one hundred and eightyfour consecutive patients with ST elevation myocardial infarction (STEMI) who underwent p-PCI. The presence or absence of fQRS on pre and post-PCI ECG and their relation with myocardial infarction and reperfusion parameters were investigated. Results: Patients with fQRS on admission of ECG or newly developed fQRS after p-PCI had increased inflammatory markers, higher cardiac enzyme levels, increased pain to balloon time, prolonged QRS time, more extended coronary involvement and more frequent Q waves on ECG in comparison to patients with absence or resolved fQRS. The presence and higher number of fQRS on admission or post-PCI ECGs were significantly related with low percent of ST resolution and myocardial reperfusion parameters. The area under the receiver operating characteristics curve values for the presence and number of fQRS to detect Thrombolysis in Myocardial Infarction Blush Grade 0 and 1, were 0.682 and 0.703. Conclusion: In our study, fQRS was significantly related to infarction and myocardial reperfusion parameters before and after p-PCI. Successful myocardial reperfusion by p-PCI caused the reduction in number of fQRS and QRS time with higher ST resolution. fQRS may be useful in identifying the patients at higher cardiac risk with increased ischemic jeopardized or infarcted myocardium, and persistent or newly developed fQRS may predict low percent of ST segment resolution in patients undergoing p-PCI.

키워드

참고문헌

  1. Das MK, Suradi H, Maskoun W, et al. Fragmented wide QRS on a 12-lead ECG: a sign of myocardial scar and poor prognosis. Circ Arrhythm Electrophysiol 2008;1:258-68. https://doi.org/10.1161/CIRCEP.107.763284
  2. Das MK, Michael MA, Suradi H, et al. Usefulness of fragmented QRS on a 12-lead electrocardiogram in acute coronary syndrome for predicting mortality. Am J Cardiol 2009;104:1631-7. https://doi.org/10.1016/j.amjcard.2009.07.046
  3. Korhonen P, Husa T, Konttila T, et al. Fragmented QRS in prediction of cardiac deaths and heart failure hospitalizations after myocardial infarction. Ann Noninvasive Electrocardiol 2010;15:130-7. https://doi.org/10.1111/j.1542-474X.2010.00353.x
  4. Das MK, Saha C, El Masry H, et al. Fragmented QRS on a 12-lead ECG: a predictor of mortality and cardiac events in patients with coronary artery disease. Heart Rhythm 2007;4:1385-92. https://doi.org/10.1016/j.hrthm.2007.06.024
  5. Pietrasik G, Goldenberg I, Zdzienicka J, Moss AJ, Zareba W. Prognostic significance of fragmented QRS complex for predicting the risk of recurrent cardiac events in patients with Q-wave myocardial infarction. Am J Cardiol 2007;100:583-6. https://doi.org/10.1016/j.amjcard.2007.03.063
  6. Das MK, Khan B, Jacob S, Kumar A, Mahenthiran J. Significance of a fragmented QRS complex versus a Q wave in patients with coronary artery disease. Circulation 2006;113:2495-501. https://doi.org/10.1161/CIRCULATIONAHA.105.595892
  7. Das MK, Zipes DP. Fragmented QRS: a predictor of mortality and sudden cardiac death. Heart Rhythm 2009;6(3 Suppl):S8-14.
  8. Cheema A, Khalid A, Wimmer A, et al. Fragmented QRS and mortality risk in patients with left ventricular dysfunction. Circ Arrhythm Electrophysiol 2010;3:339-44. https://doi.org/10.1161/CIRCEP.110.940478
  9. Das MK, El Masry H. Fragmented QRS and other depolarization abnormalities as a predictor of mortality and sudden cardiac death. Curr Opin Cardiol 2010;25:59-64. https://doi.org/10.1097/HCO.0b013e328333d35d
  10. Das MK, Maskoun W, Shen C, et al. Fragmented QRS on twelve-lead electrocardiogram predicts arrhythmic events in patients with ischemic and nonischemic cardiomyopathy. Heart Rhythm 2010;7:74-80. https://doi.org/10.1016/j.hrthm.2009.09.065
  11. Gardner PI, Ursell PC, Fenoglio JJ Jr, Wit AL. Electrophysiologic and anatomic basis for fractionated electrograms recorded from healed myocardial infarcts. Circulation 1985;72:596-611. https://doi.org/10.1161/01.CIR.72.3.596
  12. Chatterjee S, Changawala N. Fragmented QRS complex: a novel marker of cardiovascular disease. Clin Cardiol 2010;33:68-71. https://doi.org/10.1002/clc.20709
  13. Killip T 3rd, Kimball JT. Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients. Am J Cardiol 1967;20:457-64. https://doi.org/10.1016/0002-9149(67)90023-9
  14. Thygesen K, Alpert JS, White HD, et al. Universal definition of myocardial infarction. Circulation 2007;116:2634-53. https://doi.org/10.1161/CIRCULATIONAHA.107.187397
  15. Alpert JS, Thygesen K, Antman E, Bassand JP. Myocardial infarction redefined: a consensus document of The Joint European Society of Cardiology/ American College of Cardiology Committee for the redefinition of myocardial infarction. J Am Coll Cardiol 2000;36:959-69. https://doi.org/10.1016/S0735-1097(00)00804-4
  16. Antman EM, Hand M, Armstrong PW, et al. 2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with STelevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 writing group to review new evidence and update the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction, writing on behalf of the 2004 writing committee. Circulation 2008;117:296-329. https://doi.org/10.1161/CIRCULATIONAHA.107.188209
  17. Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol 1983;51:606. https://doi.org/10.1016/S0002-9149(83)80105-2
  18. The TIMI Study Group. The thrombolysis in myocardial infarction (TIMI) trial. N Engl J Med 1985;31:932-6.
  19. Gibson CM, Cannon CP, Murphy SA, et al. Relationship of TIMI myocardial perfusion grade to mortality after administration of thrombolytic drugs. Circulation 2000;101:125-30. https://doi.org/10.1161/01.CIR.101.2.125
  20. Flowers NC, Horan LG, Thomas JR, Tolleson WJ. The anatomic basis for high-frequency components in the electrocardiogram. Circulation 1969; 39:531-9. https://doi.org/10.1161/01.CIR.39.4.531
  21. Lesh MD, Spear JF, Simson MB. A computer model of the electrogram: what causes fractionation? J Electrocardiol 1988;21 Suppl:S69-73. https://doi.org/10.1016/0022-0736(88)90061-1
  22. Friedman PL, Fenoglio JJ, Wit AL. Time course for reversal of electrophysiological and ultrastructural abnormalities in subendocardial Purkinje fibers surviving extensive myocardial infarction in dogs. Circ Res 1975;36:127-44. https://doi.org/10.1161/01.RES.36.1.127
  23. Wiener I, Mindich B, Pitchon R. Fragmented endocardial electrical activity in patients with ventricular tachycardia: a new guide to surgical therapy. Am Heart J 1984;107:86-90. https://doi.org/10.1016/0002-8703(84)90138-8
  24. Basaran Y, Tigen K, Karaahmet T, et al. Fragmented QRS complexes are associated with cardiac fibrosis and significant intraventricular systolic dyssynchrony in nonischemic dilated cardiomyopathy patients with a narrow QRS interval. Echocardiography 2011;28:62-8. https://doi.org/10.1111/j.1540-8175.2010.01242.x
  25. Calore C, Cacciavillani L, Boffa GM, et al. Contrast-enhanced cardiovascular magnetic resonance in primary and ischemic dilated cardiomyopathy. J Cardiovasc Med (Hagerstown) 2007;8:821-9. https://doi.org/10.2459/JCM.0b013e3280101e3c
  26. Reddy CV, Cheriparambill K, Saul B, et al. Fragmented left sided QRS in absence of bundle branch block: sign of left ventricular aneurysm. Ann Noninvasive Electrocardiol 2006;11:132-8. https://doi.org/10.1111/j.1542-474X.2006.00094.x
  27. Mahenthiran J, Khan BR, Sawada SG, Das MK. Fragmented QRS complexes not typical of a bundle branch block: a marker of greater myocardial perfusion tomography abnormalities in coronary artery disease. J Nucl Cardiol 2007;14:347-53. https://doi.org/10.1016/j.nuclcard.2007.02.003
  28. Weinberg SL, Reynolds RW, Rosenman RH, Katz LN. Electrocardiographic changes associated with patchy myocardial fibrosis in the absence of confluent myocardial infarction; an anatomic correlative study. Am Heart J 1950;40:745-59. https://doi.org/10.1016/0002-8703(50)90203-1
  29. Varriale P, Chryssos BE. The RSR' complex not related to right bundle branch block: diagnostic value as a sign of myocardial infarction scar. Am Heart J 1992;123:369-76. https://doi.org/10.1016/0002-8703(92)90648-F
  30. Ari H, Cetinkaya S, Ari S, Koca V, Bozat T. The prognostic significance of a fragmented QRS complex after primary percutaneous coronary intervention. Heart Vessels 2012;27:20-8. https://doi.org/10.1007/s00380-011-0121-9

피인용 문헌

  1. Fragmented QRS Complex in Adult Patients With Ebstein Anomaly and Its Association With Arrhythmic Risk and the Severity of the Anomaly vol.6, pp.6, 2013, https://doi.org/10.1161/circep.113.000636
  2. J Wave and Fragmented QRS Formation During the Hyperacute Phase in Takotsubo Cardiomyopathy : – Possible Markers for Severity of Myocardial Damage – vol.78, pp.4, 2012, https://doi.org/10.1253/circj.cj-13-1296
  3. Significance of a fragmented QRS complex in patients with chronic total occlusion of coronary artery without prior myocardial infarction vol.16, pp.2, 2012, https://doi.org/10.5152/akd.2015.5887
  4. Fragmented QRS complex is a prognostic marker of microvascular reperfusion and changes in LV function occur in patients with ST elevation myocardial infarction who underwent primary percutaneous coron vol.13, pp.6, 2012, https://doi.org/10.3892/etm.2017.4380