Prognostic impact of multiple fragmented QRS on cardiac events in idiopathic dilated cardiomyopathy

Kyohei Marume, Teruo Noguchi, Tsukasa Kamakura, Emi Tateishi, Yoshiaki Morita, Hiroyuki Miura, Yuriko Nakaoku, Kunihiro Nishimura, Naoaki Yamada, Kenichi Tsujita, Chisato Izumi, Kengo Kusano, Hisao Ogawa, Satoshi Yasuda

Research output: Contribution to journalArticlepeer-review

Abstract

AIMS : To evaluate the prognostic impact of fragmented QRS (fQRS) on idiopathic dilated cardiomyopathy (DCM). METHODS AND RESULTS : We conducted a prospective observational study of 290 consecutive patients with DCM (left ventricular ejection fraction ≤ 40%) and narrow QRS who underwent cardiac magnetic resonance. We defined fQRS as the presence of various RSR' patterns in ≥2 contiguous leads representing the anterior (V1-V5), inferior (II, III, and aVF), or lateral (I, aVL, and V6) myocardial segments. Multiple fQRS was defined as the presence of fQRS in ≥2 myocardial segments. Patients were divided into three groups: no fQRS, single fQRS, or multiple fQRS. The primary endpoint was a composite of hard cardiac events consisting of heart failure death, sudden cardiac death (SCD), or aborted SCD. The secondary endpoints were all-cause death and arrhythmic event. During a median follow-up of 3.8 years (interquartile range, 1.8-6.2), 31 (11%) patients experienced hard cardiac events. Kaplan-Meier analysis showed that the rates of hard cardiac events and all-cause death were similar in the single-fQRS and no-fQRS groups and higher in the multiple-fQRS group (P = 0.004 and P = 0.017, respectively). Multivariable Cox regression identified that multiple fQRS is a significant predictor of hard cardiac events (hazard ratio, 2.23; 95% confidence interval, 1.07-4.62; P = 0.032). The multiple-fQRS group had the highest prevalence of a diffuse late gadolinium enhancement pattern (no fQRS, 21%; single fQRS, 22%; multiple fQRS, 39%; P < 0.001). CONCLUSION : Multiple fQRS, but not single fQRS, is associated with future hard cardiac events in patients with DCM.

Keywords

  • Cardiac event
  • Dilated cardiomyopathy
  • Fragmented QRS
  • Late gadolinium enhancement
  • Magnetic resonance

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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