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Transient Q-waves in an infant with asymptomatic myocardial infarction due to Kawasaki disease. Cardiol Young 2019; 29:231-234. [PMID: 30520707 DOI: 10.1017/s1047951118001919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Giant coronary artery aneurysms are a complication of Kawasaki disease and can be fatal if associated with thrombosis. We describe the clinical outcome of a boy with Kawasaki disease who exhibited "supergiant" coronary artery aneurysms at the age of 14 months and, despite treatment with anticoagulant and antiplatelet medication, developed a left coronary artery thrombosis and presented following a myocardial infarction at 2 years old. Although his symptoms were minimal, the myocardial infarction was identified by abnormal Q-waves and giant negative T-waves in precordial leads of routine electrocardiography. Intensive anticoagulant therapy combining heparin injections and high-dose warfarin was successful. The abnormal Q-waves and negative T-waves had completely disappeared 2 weeks later, likely in association with confirmed reperfusion. On the basis of prompt identification of abnormal Q-waves by electrocardiography, the patient could avoid thrombolytic therapy and catheter or surgical intervention.
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Illescas-González E, Araiza-Garaygordobil D, Sierra Lara JD, Ramirez-Salazar A, Sierra-Fernández C, Alexanderson-Rosas E. QRS-fragmentation: Case report and review of the literature. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2018; 88:124-128. [DOI: 10.1016/j.acmx.2016.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/21/2016] [Accepted: 12/21/2016] [Indexed: 10/20/2022] Open
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3
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Mani A. Fragmented QRS: A marker of hypertensive heart disease? J Clin Hypertens (Greenwich) 2017; 19:866-867. [PMID: 28721702 DOI: 10.1111/jch.13048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Arya Mani
- Department of Internal Medicine, Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT, USA.,Department of Genetics, Yale University School of Medicine, New Haven, CT, USA
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Wang DD, Tibrewala A, Nguygen P, Swadia T, Jacobsen G, Khan A, Ananthasubramaniam K. Fragmented QRS on surface electrocardiogram is not a reliable predictor of myocardial scar, angiographic coronary disease or long term adverse outcomes. Cardiovasc Diagn Ther 2014; 4:279-86. [PMID: 25276613 DOI: 10.3978/j.issn.2223-3652.2014.08.03] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 06/13/2014] [Indexed: 11/14/2022]
Abstract
PURPOSE Conflicting evidence remains regarding the value of fragmented QRS (fQRS) on surface electrocardiogram (EKG). We present the 5-year outcome of patients with fQRS on EKG and its correlation to SPECT and coronary angiography (CA). METHODS We retrospectively studied EKG's in 248 consecutive patients undergoing SPECT and CA with known or suspected coronary artery disease (CAD). The presence of fQRS or Q waves in two contiguous EKG leads was correlated with major coronary artery distributions on SPECT and cath. Patients with bundle-branch block, paced-rhythm or absence of EKG within one month of SPECT were excluded. The final EKG data for 238 patients were analyzed and compared with myocardial scar on SPECT and the presence of significant (>50%) coronary stenosis on CA. Predictors of MACE (death, MI, heart failure) were evaluated. Freedom from all-cause mortality was assessed by Kaplan-Meier analysis. RESULTS Of 238 patients, no significant difference was noted in the presence of scar on SPECT in fQRS (3/77; 3.8%) versus no fQRS (11/161; 6.8%) (P=0.56); or CA based CAD (55/77; 71% fQRS) and no fQRS (99/161, 61.4%) (P=0.20). EKG Q wave presence was similar in both groups: (12/77; 15.5% fQRS), (17/161; 10.5% no fQRS) (P=0.3). Patients with CA based significant LAD disease were 3.680 times more likely to have fQRS (P=0.04), however, fQRS was not significantly associated with MACE (P=0.92) or all-cause mortality (P=0.93). CONCLUSIONS This study does not support routine assessment of fQRS on surface EKG as a reliable predictor of SPECT myocardial scar, MACE or all-cause mortality over a long period of follow-up.
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Affiliation(s)
- Dee Dee Wang
- 1 Henry Ford Hospital, Heart and Vascular Institute, Detroit, MI, USA ; 2 Cardiovascular Physicians of North Atlanta, Roswell, Georgia
| | - Amit Tibrewala
- 1 Henry Ford Hospital, Heart and Vascular Institute, Detroit, MI, USA ; 2 Cardiovascular Physicians of North Atlanta, Roswell, Georgia
| | - Phuc Nguygen
- 1 Henry Ford Hospital, Heart and Vascular Institute, Detroit, MI, USA ; 2 Cardiovascular Physicians of North Atlanta, Roswell, Georgia
| | - Tanmay Swadia
- 1 Henry Ford Hospital, Heart and Vascular Institute, Detroit, MI, USA ; 2 Cardiovascular Physicians of North Atlanta, Roswell, Georgia
| | - Gordon Jacobsen
- 1 Henry Ford Hospital, Heart and Vascular Institute, Detroit, MI, USA ; 2 Cardiovascular Physicians of North Atlanta, Roswell, Georgia
| | - Arfaat Khan
- 1 Henry Ford Hospital, Heart and Vascular Institute, Detroit, MI, USA ; 2 Cardiovascular Physicians of North Atlanta, Roswell, Georgia
| | - Karthik Ananthasubramaniam
- 1 Henry Ford Hospital, Heart and Vascular Institute, Detroit, MI, USA ; 2 Cardiovascular Physicians of North Atlanta, Roswell, Georgia
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Uslu N, Gul M, Cakmak HA, Atam A, Pusuroglu H, Satilmisoglu H, Akkaya E, Aksu HU, Kalkan AK, Surgit O, Erturk M, Aksu H, Eksik A. The assessment of relationship between fragmented QRS complex and left ventricular wall motion score index in patients with ST elevation myocardial infarction who underwent primary percutaneous coronary intervention. Ann Noninvasive Electrocardiol 2014; 20:148-57. [PMID: 25041063 DOI: 10.1111/anec.12180] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES Fragmented QRS (fQRS) has been found to be associated with high mortality and arrhythmic events in acute coronary syndromes. Regional systolic function using wall motion score index (WMSI) is an alternative to left ventricular ejection fraction (LVEF) for the assessment of left ventricular systolic function. The aim of this study was to investigate the relation between the presence of fQRS on admission electrocardiogram (ECG) and WMSI in ST elevation myocardial infarction (STEMI) underwent primary coronary intervention (PCI). The in-hospital and long-term prognostic significance of persistent fQRS was also evaluated. METHODS In this retrospective study, 542 patients with a diagnose of STEMI underwent primary PCI were included. Study patients were divided into two groups according to the presence (n = 153) or absence (n = 389) of a fQRS on admission ECG. RESULTS WMSI was found to be significantly higher in fQRS(+) group compared to the fQRS(-) group (P < 0.001). In multivariete analysis, WMSI was found to be an independent predictor of fQRS, and fQRS was inversely associated with LVEF. The in-hospital reinfarction (P = 0.003), MACE (P = 0.024), intraaortic balloon pump use (P = 0.014), and advanced heart failure (P < 0.001) were found to be significantly more frequent in the fQRS(+) group. The presence of fQRS on admission was found to be associated with an increase in long-term cardiovascular mortality (P = 0.028), and long-term all-cause mortality (P = 0.022). CONCLUSION WMSI was significantly related with the presence of the fQRS, which reflects the linking between impairment of regional left ventricular systolic function and the presence of severe myocardial injury in STEMI.
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Affiliation(s)
- Nevzat Uslu
- Cardiology Department, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Stavileci B, Cimci M, Ikitimur B, Barman HA, Ozcan S, Ataoglu E, Enar R. Significance and usefulness of narrow fragmented QRS complex on 12-lead electrocardiogram in acute ST-segment elevation myocardial infarction for prediction of early mortality and morbidity. Ann Noninvasive Electrocardiol 2014; 19:338-44. [PMID: 24517503 DOI: 10.1111/anec.12133] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The presence of notched R or S waves without accompanying typical bundle branch blocks, or the existence of an additional wave like RSR' pattern in the original QRS complex (with a duration of <120 ms) has been defined as narrow QRS fragmentation. Persistence of the fQRS found on the admission electrocardiogram (ECG) in patients with acute ST segment elevation myocardial infarction (STEMI) will have prognostic significance in the short term. METHODS The study was carried out using retrospectively collected data of 296 consecutive patients diagnosed as acute STEMI .fQRS group had fQRS both in admission and latest ECGs (n = 80, 27%), and non-fQRS group had no fQRS in last ECG (n = 216, 73%). Primary end points were in-hospital cardiovascular mortality, hemodynamic instability, and electrical instability. RESULTS MI localization, symptom duration, reperfusion therapy (RPT) rate, RPT modality, rate of successful reperfusion did not differ. Mean ejection fraction was lower and all end points were more frequent in the fQRS group. Irrespective of the RPT modality and success of RPT, mortality rate was higher in patients with persistent fQRS. GRACE score >120 points (OR = 4.765), age >70 years (OR = 4.041), anterior MI localization (OR = 3.148), and presence of fQRS (OR = 2.484) were significant predictors of primary end points. fQRS increased the predictive ability of GRACE score >120 about two folds (OR = 7.305, P < 0.001). CONCLUSION Persistent fQRS on ECG is associated with poor prognosis and there is a lack of expected mortality benefit of RPT, particularly that of fibrinolytic therapy, in STEMI patients with fQRS.
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Affiliation(s)
- Berna Stavileci
- Cerrahpasa School of Medicine, Department of Cardiology, Istanbul University, Istanbul, Turkey
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Ahn MS, Kim JB, Yoo BS, Lee JW, Lee JH, Youn YJ, Ahn SG, Kim JY, Lee SH, Yoon J, Choe KH. Fragmented QRS complexes are not hallmarks of myocardial injury as detected by cardiac magnetic resonance imaging in patients with acute myocardial infarction. Int J Cardiol 2013; 168:2008-13. [DOI: 10.1016/j.ijcard.2012.12.086] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 11/09/2012] [Accepted: 12/28/2012] [Indexed: 12/21/2022]
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Precordial R-wave reappearance predicting infarct size and myocardial recovery after acute STEMI. Neth Heart J 2012; 20:326-9. [PMID: 21611849 PMCID: PMC3402577 DOI: 10.1007/s12471-011-0162-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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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. [PMID: 17697810 DOI: 10.1016/j.amjcard.2007.03.063] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Revised: 03/08/2007] [Accepted: 03/08/2007] [Indexed: 10/23/2022]
Abstract
There are limited data regarding the prognostic value of QRS complex fragmentation, defined as changes in QRS morphology (<120 ms) with different RSR' patterns: additional R waves, notched S wave, or >1 R' wave. The purpose of our analysis was to assess the prognostic value of presence of Q waves and QRS fragmentation for predicting recurrent cardiac events, defined as cardiac death, nonfatal myocardial infarction (MI), or unstable angina, whichever occurs first, in 350 patients with first Q-wave MI. In follow-up (2 months on average) electrocardiograms (ECGs), 277 patients (79%) had persistent Q waves and 73 (21%) had resolution of Q waves. Independently of Q waves, presence of QRS complex fragmentation was found in 187 patients (53%). Resolved Q waves on 2-month ECGs was associated with worsened prognosis (adjusted hazard ratio [HR] 2.33, p = 0.007), whereas presence of any fragmented QRS did not increase risk of recurrent cardiac events (adjusted HR 0.93, p = 0.79). Among patients for whom Q waves disappeared on 2-month ECGs, patients with QRS fragmentation (n = 37) had over twofold higher risk of recurrent events (adjusted HR 2.68, p = 0.004) compared with those without fragmented QRS and persistent Q waves. In conclusion, presence of fragmented QRS independently of Q waves was not associated with increased risk of recurrent events in the general population of patients after MI. However, among patients with resolved Q waves, fragmented QRS was associated with increased risk of cardiac events. Fragmented QRS complex should not be neglected in patients with transient Q waves after myocardial infarction.
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Affiliation(s)
- Grzegorz Pietrasik
- Heart Research Follow-up Program, Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
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Das MK, Saha C, El Masry H, Peng J, Dandamudi G, Mahenthiran J, McHenry P, Zipes DP. 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. [PMID: 17954396 DOI: 10.1016/j.hrthm.2007.06.024] [Citation(s) in RCA: 221] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2006] [Accepted: 06/27/2007] [Indexed: 11/26/2022]
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 (> or =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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Affiliation(s)
- Mithilesh Kumar Das
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
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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. [PMID: 16717150 DOI: 10.1161/circulationaha.105.595892] [Citation(s) in RCA: 412] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Q waves on a 12-lead ECG are markers of a prior myocardial infarction (MI). However, they may regress or even disappear over time, and there is no specific ECG sign of a non-Q-wave MI. Fragmented QRS complexes (fQRSs), which include various RSR' patterns, without a typical bundle-branch block are markers of altered ventricular depolarization owing to a prior myocardial scar. We postulated that the presence of an fQRS might improve the ability to detect a prior MI compared with Q waves alone by ECG. METHODS AND RESULTS A cohort of 479 consecutive patients (mean+/-SD age, 58.2+/-13.2 years; 283 males) who were referred for nuclear stress tests was studied. The fQRS included various morphologies of the QRS (<120 ms), which included an additional R wave (R') or notching in the nadir of the S wave, or >1 R' (fragmentation) in 2 contiguous leads, corresponding to a major coronary artery territory. The Q wave was present in 71 (14.8%) patients, an fQRS was present in 191 (34.9%) patients, and an fQRS and/or a Q wave was present in 203 (42.3%) patients. Sensitivity, specificity, and the negative predictive value for myocardial scar as detected by single photon emission computed tomography analysis were 36.3%, 99.2%, and 70.8%, respectively, for the Q wave alone; 85.6%, 89%, and 92.7%, respectively, for the fQRS; and 91.4%, 89%, and 94.2%, respectively, for the Q wave and/or fQRS. CONCLUSIONS The fQRS on a 12-lead ECG is a marker of a prior MI, defined by regional perfusion abnormalities, which has a substantially higher sensitivity and negative predictive value compared with the Q wave.
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Affiliation(s)
- Mithilesh K Das
- Krannert Institute of Cardiology, Indiana School of Medicine, Indianapolis, IN, USA.
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Voon WC, Chen YW, Hsu CC, Lai WT, Sheu SH. Q-wave regression after acute myocardial infarction assessed by Tl-201 myocardial perfusion SPECT. J Nucl Cardiol 2004; 11:165-70. [PMID: 15052248 DOI: 10.1016/j.nuclcard.2003.10.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The actual relationship between the interval change of myocardial thallium 201 (Tl-201) radioactivity in the infarct area and the pattern of Q-wave regression is still unknown. This study was conducted to evaluate their relationship after acute myocardial infarction (AMI). METHODS AND RESULTS A total of 30 patients who had a first Q-wave AMI (11 without Q-wave regression and 19 with Q-wave regression) were retrospectively included. Two sets of 12-lead surface electrocardiograms and Tl-201 myocardial perfusion images were obtained 0 to 2 months and 14 to 84 months after the AMI event, respectively. The acute/subacute redistribution Tl-201 radioactivity was similar between the patients with and those without Q-wave regression. However, the patients with Q-wave regression had higher chronic redistribution Tl-201 radioactivity than those without Q-wave regression. Moreover, the patients with Q-wave regression presented a higher gradient in the redistribution Tl-201 radioactivity between the chronic and acute/subacute images than those without Q-wave regression. CONCLUSIONS This study supports the role of functional recovery of stunning and/or hibernating myocardium in the disappearance of Q waves after AMI.
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Affiliation(s)
- Wen-Chol Voon
- Department of Cardiology, Kaohsiung Medical University, Kaosiung, Taiwan.
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Evaluation of regional myocardial perfusion in areas of old myocardial infarction after revascularization by means of intraoperative myocardial contrast echocardiography. J Thorac Cardiovasc Surg 1994. [DOI: 10.1016/s0022-5223(94)70155-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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