9 / 11
Page 42
allied
academies
Curr Trend Cardiol. 2017 | Volume 1 Issue 3
September 18-19, 2017 | Toronto, Canada
Annual Conference on
HEART DISEASES
Background:
Coronary heart disease (CHD) is one of the
major and leading causes of death worldwide. Fragmented
QRS (f-QRS) is a pattern of QRS complex in 12 leads surface
ECG which has a great diagnostic and prognostic role in
cardiac diseases including coronary heart disease.
Objective:
to investigate the role of using f-QRS in acute
coronary syndrome (ACS) as a non-invasive and easily
accessible tool for the prediction of myocardial damage.
Methods & Results:
Retrospective study of 84 patients with
ACS were divided into 46 patients with f-QRS (fragmented
group) and 38 patients without f-QRS (non-fragmented
group) excluding prior history of major ischemic events (MI,
PCI & CABG), permanent AF or ischemic and non-ischemic
cardiomyopathy. General demographic characteristics,
major risk factors of CHD, Killip class, updated GRACE risk
score of ACS, cardiac biomarkers, wall motion score index
(WMSI), left ventricle ejection fraction (LVEF), diastolic
dysfunction (DD), mitral regurgitation (MR), Gensini score
and in-hospital death showed no significant differences
between both groups. Only LVEDD was significantly higher
in fragmented group than non-fragmented group (P=0.033).
The optimum cut off value for f-QRS leads was >3 leads
for predicting in-hospital death with 83.3% sensitivity and
72.5% specificity. In the fragmented group, patients were
divided into 2 subgroups according to the numbers of f-QRS
leads; Subgroup (A1) including patients with >3 f-QRS leads
&subgroup (A2) including patients ≤3 f-QRS leads. Subgroup
(A1) showed significant difference than subgroup (A2); a
lower SBP (111.33±25.03 vs. 139±38.89, P=0.016), a higher
HR (93.81±19.13 vs. 80.77±14.91, P=0.014), a higher updated
GRACE risk score (6.81 ± 12 vs. 3.22 ± 6.95, P=0.048),a
lower LVEF (48.08±13.07 vs. 56.14±10.92, P=0.049),a higher
WMSI (1.55±0.33 vs. 1.27±0.27, P=0.007), a higher Gensini
score (86.12±47.2 vs. 55.08±35.97, P=0.030) and a higher
incidence of in-hospital death (5/16 vs. 1/30, P=0.015).
The different locations of f-QRS had different impacts on
SBP, HR, Killip (IV), LVEF, WMSI, updated GRACE score,
Gensini score and in hospital death. Anterior f-QRS showed
significant differences than non-anterior f-QRS; with a lower
SBP (P=0.006), a higher HR (P=0.040), a higher incidence of
Killip (IV) (P=0.030), a lower LVEF (P=0.039), a higher WMSI
(P=0.004), a higher updated GRACE risk score (P= 0.033), a
higher Gensini score (P=0.016) and a higher incidence of in-
hospital mortality (P=0.004).
Conclusion:
Fragmented QRS on 12 leads surface ECG is not
an uncommon phenomenon among the patients with acute
coronary syndrome (ACS). The location and the number of
f-QRS can be used as a non-invasive and easily accessible
tool to predict the extent of myocardial damage.
e:
ahmadsalahyounis@gmail.comRole of fragmented QRS complex in the prediction of the extent of myocardial damage following acute
coronary syndrome (ACS)
Ahmad Salah Younis, Nora Ismaeel Mohammad, Moataz Ibrahim El-Halag
and
Mahmoud Ali El-Badry
Cairo University, Egypt