Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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The Presence of Fragmented QRS on 12-Lead Electrocardiography in Patients with Coronary Artery Ectasia

  • Sen, Fatih (Turkey Yuksek Ihtisas Education and Research Hospital, Cardiology Clinic) ;
  • Yilmaz, Samet (Turkey Yuksek Ihtisas Education and Research Hospital, Cardiology Clinic) ;
  • Kuyumcu, Mevlut Serdar (Turkey Yuksek Ihtisas Education and Research Hospital, Cardiology Clinic) ;
  • Ozeke, Ozcan (Turkey Yuksek Ihtisas Education and Research Hospital, Cardiology Clinic) ;
  • Balci, Mustafa Mucahit (Turkey Yuksek Ihtisas Education and Research Hospital, Cardiology Clinic) ;
  • Aydogdu, Sinan (Turkey Yuksek Ihtisas Education and Research Hospital, Cardiology Clinic)
  • Received : 2014.04.30
  • Accepted : 2014.08.04
  • Published : 2014.05.30
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Abstract

Background and Objectives: Coronary artery ectasia (CAE) is an angiographic finding characterized by dilation of an arterial segment with a diameter at least 1.5 times that of its adjacent normal coronary artery. Fragmented QRS (fQRS) complexes are electrocardiographic signals which reflect altered ventricular conduction around regions of a myocardial scar and/or ischaemia. In the present study, we aimed to evaluate the presence of fQRS in patients with CAE. Subjects and Methods: The study population included 100 patients with isolated CAE without coronary artery disease (CAD) and 80 angiographically normal controls. fQRS was defined as the presence of an additional R wave or notching of R or S wave or the presence of fragmentation in two contiguous leads corresponding to a major coronary artery territory. Results: The two groups were similar in terms of age, sex, hypertension, dyslipidemia, and family history of CAD. The presence of fQRS was significantly (p<0.05) higher in the CAE group than that in the normal coronary artery group (29% vs. 6.2%, p=0.008). Isolated CAE were detected most commonly in the right coronary artery (61%), followed by left anterior descending artery (52%), left circumflex artery (36%), and left main artery (9%). Multivariate stepwise logistic regression analysis showed that CAE {odds ratio (OR) 1.412; 95% confidence interval (CI) 1.085-1.541; p=0.003} and diabetes (OR 1.310; 95% CI 1.025-1.482; p=0.041) were independently associated with fQRS. Conclusion: The presence of fragmented QRS associated with increased risk for arrhythmias and cardiovascular mortality was significantly higher in patients with CAE than in patient with normal coronary artery. Further studies are needed to determine whether the presence of fragmented QRS is a possible new risk factor for patients with CAE.

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References

  1. Satran A, Bart BA, Henry CR, et al. Increased prevalence of coronary artery aneurysms among cocaine users. Circulation 2005;111:2424-9. https://doi.org/10.1161/01.CIR.0000165121.50527.DE
  2. Li JJ, He JG, Nan JL, He ZX, Zhu CG, Li J. Is systemic inflammation responsible for coronary artery ectasia? Int J Cardiol 2008;130:e69-70. https://doi.org/10.1016/j.ijcard.2007.07.006
  3. Falsetti HL, Carrol RJ. Coronary artery aneurysm. A review of the literature with a report of 11 new cases. Chest 1976;69:630-6. https://doi.org/10.1378/chest.69.5.630
  4. Befeler B, Aranda MJ, Embi A, Mullin FL, El-Sherif N, Lazzara R. Coronary artery aneurysms: study of the etiology, clinical course and effect on left ventricular function and prognosis. Am J Med 1977;62:597-607. https://doi.org/10.1016/0002-9343(77)90423-5
  5. Kruger D, Stierle U, Herrmann G, Simon R, Sheikhzadeh A. Exercise-induced myocardial ischemia in isolated coronary artery ectasias and aneurysms ("dilated coronopathy"). J Am Coll Cardiol 1999;34:1461-70. https://doi.org/10.1016/S0735-1097(99)00375-7
  6. Mattern AL, Baker WP, McHale JJ, Lee DE. Congenital coronary aneurysms with angina pectoris and myocardial infarction treated with saphenous vein bypass graft. Am J Cardiol 1972;30:906-9. https://doi.org/10.1016/0002-9149(72)90019-7
  7. Akyurek O, Berkalp B, Sayin T, Kumbasar D, Kervanciog lu C, Oral D. Altered coronary flow properties in diffuse coronary artery ectasia. Am Heart J 2003;145:66-72. https://doi.org/10.1067/mhj.2003.48
  8. Tigen K, Karaahmet T, Gurel E, et al. The utility of fragmented QRS complexes to predict significant intraventricular dyssynchrony in nonischemic dilated cardiomyopathy patients with a narrow QRS interval. Can J Cardiol 2009;25:517-22. https://doi.org/10.1016/S0828-282X(09)70137-0
  9. 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
  10. Michael MA, El Masry H, Khan BR, Das MK. Electrocardiographic signs of remote myocardial infarction. Prog Cardiovasc Dis 2007;50:198-208. https://doi.org/10.1016/j.pcad.2007.05.003
  11. 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
  12. Take Y, Morita H, Toh N, et al. Identification of high-risk syncope related to ventricular fibrillation in patients with Brugada syndrome. Heart Rhythm 2012;9:752-9. https://doi.org/10.1016/j.hrthm.2011.11.045
  13. 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
  14. Markis JE, Joffe CD, Cohn PF, Feen DJ, Herman MV, Gorlin R. Clinical significance of coronary arterial ectasia. Am J Cardiol 1976;37:217-22. https://doi.org/10.1016/0002-9149(76)90315-5
  15. Aydin M, Tekin IO, Dogan SM, et al. The levels of tumor necrosis factor- alpha and interleukin-6 in patients with isolated coronary artery ectasia. Mediators Inflamm 2009;2009:106145.
  16. Dogan A, Tuzun N, Turker Y, Akcay S, Kaya S, Ozaydin M. Matrix metalloproteinases and inflammatory markers in coronary artery ectasia: their relationship to severity of coronary artery ectasia. Coron Artery Dis 2008;19:559-63. https://doi.org/10.1097/MCA.0b013e3283109079
  17. Finkelstein A, Michowitz Y, Abashidze A, Miller H, Keren G, George J. Temporal association between circulating proteolytic, inflammatory and neurohormonal markers in patients with coronary ectasia. Atherosclerosis 2005;179:353-9. https://doi.org/10.1016/j.atherosclerosis.2004.10.020
  18. Aboeata AS, Sontineni SP, Alla VM, Esterbrooks DJ. Coronary artery ectasia: current concepts and interventions. Front Biosci (Elite Ed) 2012; 4:300-10.
  19. Huang QJ, Liu J, Chen MH, Li JJ. Relation of diabetes to coronary artery ectasia: a meta-analysis study. Anadolu Kardiyol Derg 2014;14:322-7. https://doi.org/10.5152/akd.2014.5327
  20. Boles U, Eriksson P, Zhao Y, Henein MY. Coronary artery ectasia: remains a clinical dilemma. Coron Artery Dis 2010;21:318-20. https://doi.org/10.1097/MCA.0b013e32833b20da
  21. Farto e Abreu P, Mesquita A, Silva JA, Seabra-Gomes R. [Coronary artery ectasia: clinical and angiographic characteristics and prognosis]. Rev Port Cardiol 1993;12:305-10.
  22. Priori SG, Gasparini M, Napolitano C, et al. Risk stratification in Brugada syndrome: results of the PRELUDE (PRogrammed ELectrical stimUlation preDictive valuE) registry. J Am Coll Cardiol 2012;59:37-45. https://doi.org/10.1016/j.jacc.2011.08.064
  23. 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
  24. Femenia F, Arce M, Arrieta M, Baranchuk A. Surface fragmented QRS in a patient with hypertrophic cardiomyopathy and malignant arrhythmias: is there an association? J Cardiovasc Dis Res 2012;3:32-5. https://doi.org/10.4103/0975-3583.91602
  25. Sha J, Zhang S, Tang M, Chen K, Zhao X, Wang F. Fragmented QRS is associated with all-cause mortality and ventricular arrhythmias in patient with idiopathic dilated cardiomyopathy. Ann Noninvasive Electrocardiol 2011;16:270-5. https://doi.org/10.1111/j.1542-474X.2011.00442.x
  26. Baranchuk A, Miranda R, Femenia F; FECHA Investigators. Chagas' cardiomyopathy and Fragmented QRS. Re: QRS fragmentation as a marker of arrhythmias in coronary artery disease, in cardiomyopathies and ion channel diseases. Int J Cardiol 2012;160:151-2. https://doi.org/10.1016/j.ijcard.2012.05.072
  27. Haraoka K, Morita H, Saito Y, et al. Fragmented QRS is associated with torsades de pointes in patients with acquired long QT syndrome. Heart Rhythm 2010;7:1808-14. https://doi.org/10.1016/j.hrthm.2010.09.008
  28. Das MK, Zipes DP. Fragmented QRS: a predictor of mortality and sudden cardiac death. Heart Rhythm 2009;6(3 Suppl):S8-14.
  29. Nagata K, Kawasaki T, Okamoto A, et al. Effectiveness of an antiplatelet agent for coronary artery ectasia associated with silent myocardial ischemia. Jpn Heart J 2001;42:249-54. https://doi.org/10.1536/jhj.42.249