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Electrocardiographic QRS Fragmentation as a Marker for Myocardial Fibrosis in Hypertrophic Cardiomyopathy
Author(s) -
KONNO TETSUO,
HAYASHI KENSHI,
FUJINO NOBORU,
OKA RIE,
NOMURA AKIHIRO,
NAGATA YOJI,
HODATSU AKIHIKO,
SAKATA KENJI,
FURUSHO HIROSHI,
TAKAMURA MASAYUKI,
NAKAMURA HIROYUKI,
KAWASHIRI MASAAKI,
YAMAGISHI MASAKAZU
Publication year - 2015
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.12742
Subject(s) - medicine , hypertrophic cardiomyopathy , cardiology , myocardial fibrosis , pathological , fibrosis , cardiomyopathy , qrs complex , magnetic resonance imaging , electrocardiography , heart failure , radiology
fQRS Predicts Myocardial Fibrosis in HCM Introduction Myocardial fibrosis in patients with hypertrophic cardiomyopathy (HCM) usually shows a patchy distribution, which may not be detected by pathological Q waves on 12‐lead ECGs. Fragmented QRS complexes (fQRS) reflect intraventricular conduction delay and can be a marker of myocardial fibrosis. We assessed whether fQRS show better correlation with myocardial fibrosis than pathological Q waves in HCM. Methods and Results This cross‐sectional study included 108 patients with HCM who underwent 12‐lead ECG and cardiac magnetic resonance imaging with late gadolinium enhancement (LGE‐CMR). The number of leads with pathological Q waves was not correlated with the extent of LGE measured at any different standard deviations (SDs) (2, 4, 6, 8, and 10 SD), whereas the number of leads with fQRS showed the best correlation with LGE at 6 SD (r = 0.32, P = 0.0008). Further, the number of leads with fQRS was an independent predictor for the extent of LGE at 6 SD. fQRS showed higher accuracy for detecting myocardial fibrosis defined by LGE at 6 SD than pathological Q waves; the overall sensitivity, specificity, and accuracy of fQRS were 40%, 80%, and 64%, respectively, whereas those of pathological Q waves were 7%, 97%, and 60%, respectively. fQRS in lateral leads showed the highest accuracy (75%), followed by inferior leads (59%) and anterior leads (57%), for detecting LGE at 6 SD in the corresponding left ventricular segment. Conclusions These findings suggest that fQRS may have a substantially higher sensitivity and diagnostic accuracy compared with pathological Q waves for detecting myocardial fibrosis in HCM.