Prevalence and Prognostic Significance of Fragmented QRS Complex in Middle-Aged Subjects With and Without Clinical or Electrocardiographic Evidence of Cardiac Disease

详细信息    查看全文

• 作者：Henri K. Terho ; BM^a ; ^{hterho@student.oulu.fi" class="auth_mail} ; Jani T. Tikkanen ; MD^a ; Juhani M. Junttila ; MD^a ; Olli Anttonen ; MD^b ; Tuomas V. Kentt&auml ; MSc ; PhD^a ; Aapo L. Aro ; MD^c ; Tuomas Kerola ; MD^b ; Harri A. Rissanen ; MSc^d ; Antti Reunanen ; MD^d ; Heikki V. Huikuri ; MD^a
• 刊名：The American Journal of Cardiology
• 出版年：1 July 2014
• 年：2014
• 卷：114
• 期：1
• 页码：141-147
• 全文大小：2260 K

文摘

We wanted to evaluate the prevalence and prognostic value of the fragmented QRS (fQRS) complex, defined as changes in QRS morphology with various RSR′-patterns in 12-lead electrocardiogram (ECG) in a middle-aged general population. We evaluated the 12-lead ECGs of 10,904 Finnish middle-aged subjects (52% men, mean age 44 ± 8.5 years) with (n = 2,543) and without (n = 8,361) an evidence of cardiac disease drawn from general population and followed them for 30 ± 11 years. Fragmentation of the QRS complex was defined as various RSR′-patterns in at least 2 consecutive leads within the same territory (inferior II, III, aVF; lateral I, aVL, V4 to V6; anterior V1 to V3). Primary end points were death from any cause, cardiac, and arrhythmic deaths. In the total population, fQRS was present in 19.7% (n = 2,147) of subjects, including 15.7% (n = 1714) in inferior leads, 0.8% (n = 84) in lateral leads, and 2.9% (n = 314) in anterior leads. Fragmentation was not associated with increased mortality in subjects without a known cardiac disease. However, fQRS observed in lateral leads in subjects with an evidence of cardiac disease was associated with an increased risk of all-cause (p = 0.001), cardiac (p = 0.001), and arrhythmic (p = 0.004) mortalities. In conclusion, fQRS reflecting minor intraventricular conduction defect is a common finding, especially in the inferior leads, but it is not a sign of increased risk of mortality in subjects without a known cardiac disease. Lateral fQRS, which is less commonly observed in the ECG, is associated with a worse outcome in patients with a known cardiac disease.