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Fragmented QRS complexes on a 12-lead ECG as a marker of non-coronary artery disease related myocardial disease by gadolinium delayed enhancement cardiac magnetic resonance imaging

Background

We have demonstrated that fragmented QRS complexes (fQRS) on a 12-lead ECG correlate with the presence of myocardial scar in coronary artery disease (CAD). However, the extent of fQRS as a marker of non-CAD related myocardial pathology as seen on delayed gadolinium enhancement (GDE) cardiac magnetic resonance imaging (CMR) is unknown.

Methods

The fQRS on 12-lead ECG was defined as the presence of fragmented QRS, notched R or S wave, or RSR' pattern in at least 2 contiguous leads corresponding to an individual coronary artery region (anterior: V1 to V6 leads, lateral: I, aVL and V5, V6 leads, and inferior: II, III and aVF leads, respectively) in absence of a typical bundle branch block pattern (Figure 1). CMR studies of 91 patients (pts) with GDE (0.1 mmol/kg Gadolinium) and ECG were studied. Presence of non-subendocardial and patchy or diffuse mid to subepicardial GDE patterns was considered abnormal. Pts with CAD, prior myocardial infarction, and transmural/subendocardial GDE were excluded (n = 34).

Figure 1
figure1

Different morphologies of fQRS on 12-lead ECG.

Results

Of 57 pts (mean age 41 ± 15 years, 41% male), 17 (30%) pts had fQRS on their 12-lead ECG and 8(14%) pts had abnormal non-CAD-related GDE. The CMR exams were performed for dilated cardiomyopthy (n = 9), myocarditis (n = 5), constrictive pericarditis (n = 6), arrhythmia (n = 14), intracardiac mass (n = 7), sarcoidosis (n = 11), and suspected amyloidosis (n = 2) or hemochromatosis (n = 3). Sensitivity and specificity of detecting non-CAD related myocardial pathology by fQRS on ECG were 88% and 80% respectively p < 0.001. Results with analysis of anterior, lateral and inferior fQRS are summarized in Table 1.

Table 1 Table 1

Conclusion

Fragmented QRS complexes on a 12-lead ECG is reliable marker of both CAD and non-CAD related myocardial disease with a high degree of specificity to localize the region of the involved myocardium.

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Correspondence to Mohamed Homsi.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Homsi, M., Alsayed, L., Safadi, A. et al. Fragmented QRS complexes on a 12-lead ECG as a marker of non-coronary artery disease related myocardial disease by gadolinium delayed enhancement cardiac magnetic resonance imaging. J Cardiovasc Magn Reson 11, P58 (2009). https://doi.org/10.1186/1532-429X-11-S1-P58

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Keywords

  • Amyloidosis
  • Cardiac Magnetic Resonance
  • Cardiac Magnetic Resonance Imaging
  • Hemochromatosis
  • Constrictive Pericarditis