Tags

Type your tag names separated by a space and hit enter

Fragmented QRS complexes predict right ventricular dysfunction and outflow tract aneurysms in patients with repaired tetralogy of Fallot.
Int J Cardiol. 2013 Aug 20; 167(4):1366-72.IJ

Abstract

BACKGROUND

Fragmented QRS complexes (fQRS) correlate with myocardial scar, and may predict arrhythmias in patients with repaired tetralogy of Fallot (TOF). We investigated the relationship between fQRS in operated TOF patients with right ventricular (RV) dysfunction and RV outflow tract (RVOT) aneurysm.

METHODS

We studied 56 operated TOF patients with moderate/severe pulmonary regurgitation, referred for cardiac magnetic resonance imaging (MRI) over a 4.5 year period. The presence of fQRS (additional notches in the R/S wave in ≥ 2 contiguous leads on the ECG) was correlated with MRI findings.

RESULTS

fQRS was observed in 44 (78.6%) patients. Patients with fQRS had significantly larger RV end diastolic volume index (RVEDVi; 162 ml vs 141 ml, p=0.028) and RV end systolic volume index (RVESVi; 88 ml vs 70 ml, p=0.031). Increasing number of leads with fragmentation was independently associated with increasingly lower RV ejection fraction (adjusted co-efficient -0.97, 95%CI -1.83 to -0.12, p=0.026), greater pulmonary regurgitation fraction (1.65, 0.28 to 3.01, p=0.019), larger RVEDVi (6.78, 2.00 to 11.56, p=0.006) and RVESVi (5.41, 1.66 to 9.15, p=0.005). Anterior fragmentation correlated most significantly with RV dysfunction (p<0.05). fQRS had no significant association with LV dysfunction. Presence of any fQRS (OR 17.5, 95%CI 2.1-147.8, p=0.009) and inferior fQRS (OR 9.0, 95%CI 2.7-30.1, p<0.001) were found to be significant predictors for RVOT aneurysm.

CONCLUSIONS

The presence of fQRS on the ECG is significantly associated with RV dysfunction and RVOT aneurysms in repaired TOF patients. Increasing burden of fragmentation, especially in the anterior leads, is associated with increasing RV dysfunction.

Authors+Show Affiliations

National Heart Centre Singapore, Singapore.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22521381

Citation

Shanmugam, Nesan, et al. "Fragmented QRS Complexes Predict Right Ventricular Dysfunction and Outflow Tract Aneurysms in Patients With Repaired Tetralogy of Fallot." International Journal of Cardiology, vol. 167, no. 4, 2013, pp. 1366-72.
Shanmugam N, Yap J, Tan RS, et al. Fragmented QRS complexes predict right ventricular dysfunction and outflow tract aneurysms in patients with repaired tetralogy of Fallot. Int J Cardiol. 2013;167(4):1366-72.
Shanmugam, N., Yap, J., Tan, R. S., Le, T. T., Gao, F., Chan, J. X., Chong, D., Ho, K. L., Tan, B. Y., Ching, C. K., Teo, W. S., Tan, J. L., & Liew, R. (2013). Fragmented QRS complexes predict right ventricular dysfunction and outflow tract aneurysms in patients with repaired tetralogy of Fallot. International Journal of Cardiology, 167(4), 1366-72. https://doi.org/10.1016/j.ijcard.2012.04.004
Shanmugam N, et al. Fragmented QRS Complexes Predict Right Ventricular Dysfunction and Outflow Tract Aneurysms in Patients With Repaired Tetralogy of Fallot. Int J Cardiol. 2013 Aug 20;167(4):1366-72. PubMed PMID: 22521381.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fragmented QRS complexes predict right ventricular dysfunction and outflow tract aneurysms in patients with repaired tetralogy of Fallot. AU - Shanmugam,Nesan, AU - Yap,Jonathan, AU - Tan,Ru San, AU - Le,Thu Thao, AU - Gao,Fei, AU - Chan,Jia Xin, AU - Chong,Daniel, AU - Ho,Kah Leng, AU - Tan,Boon Yew, AU - Ching,Chi Keong, AU - Teo,Wee Siong, AU - Tan,Ju Le, AU - Liew,Reginald, Y1 - 2012/04/21/ PY - 2012/03/26/received PY - 2012/04/01/accepted PY - 2012/4/24/entrez PY - 2012/4/24/pubmed PY - 2014/4/12/medline KW - BBB KW - CI KW - ECG KW - EDV KW - EF KW - ESV KW - Fragmented QRS KW - LGE KW - LV KW - MRI KW - NPV KW - NYHA KW - New York Heart Association KW - PPV KW - PR KW - RV KW - RV dysfunction KW - RV outflow tract aneurysm KW - RVOT KW - Repaired tetralogy of Fallot KW - SCD KW - TOF KW - bundle branch block KW - confidence interval KW - ejection fraction KW - electrocardiogram KW - end diastolic volume KW - end systolic volume KW - fQRS KW - fragmented QRS KW - i KW - indexed KW - late gadolinium enhanced KW - left ventricle KW - magnetic resonance imaging KW - negative predictive value KW - positive predictive value KW - pulmonary regurgitation KW - right ventricle KW - right ventricular outflow tract KW - sudden cardiac death KW - tetralogy of Fallot SP - 1366 EP - 72 JF - International journal of cardiology JO - Int. J. Cardiol. VL - 167 IS - 4 N2 - BACKGROUND: Fragmented QRS complexes (fQRS) correlate with myocardial scar, and may predict arrhythmias in patients with repaired tetralogy of Fallot (TOF). We investigated the relationship between fQRS in operated TOF patients with right ventricular (RV) dysfunction and RV outflow tract (RVOT) aneurysm. METHODS: We studied 56 operated TOF patients with moderate/severe pulmonary regurgitation, referred for cardiac magnetic resonance imaging (MRI) over a 4.5 year period. The presence of fQRS (additional notches in the R/S wave in ≥ 2 contiguous leads on the ECG) was correlated with MRI findings. RESULTS: fQRS was observed in 44 (78.6%) patients. Patients with fQRS had significantly larger RV end diastolic volume index (RVEDVi; 162 ml vs 141 ml, p=0.028) and RV end systolic volume index (RVESVi; 88 ml vs 70 ml, p=0.031). Increasing number of leads with fragmentation was independently associated with increasingly lower RV ejection fraction (adjusted co-efficient -0.97, 95%CI -1.83 to -0.12, p=0.026), greater pulmonary regurgitation fraction (1.65, 0.28 to 3.01, p=0.019), larger RVEDVi (6.78, 2.00 to 11.56, p=0.006) and RVESVi (5.41, 1.66 to 9.15, p=0.005). Anterior fragmentation correlated most significantly with RV dysfunction (p<0.05). fQRS had no significant association with LV dysfunction. Presence of any fQRS (OR 17.5, 95%CI 2.1-147.8, p=0.009) and inferior fQRS (OR 9.0, 95%CI 2.7-30.1, p<0.001) were found to be significant predictors for RVOT aneurysm. CONCLUSIONS: The presence of fQRS on the ECG is significantly associated with RV dysfunction and RVOT aneurysms in repaired TOF patients. Increasing burden of fragmentation, especially in the anterior leads, is associated with increasing RV dysfunction. SN - 1874-1754 UR - https://www.unboundmedicine.com/medline/citation/22521381/Fragmented_QRS_complexes_predict_right_ventricular_dysfunction_and_outflow_tract_aneurysms_in_patients_with_repaired_tetralogy_of_Fallot_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0167-5273(12)00408-1 DB - PRIME DP - Unbound Medicine ER -