Fragmented QRS on surface electrocardiogram as a predictor of perfusion defect in patients with suspected coronary artery disease undergoing myocardial perfusion imaging

• Published in: Indian heart journal Vol. 70; no. Suppl 3; pp. S177 - S181
• Main Authors: Hekmat, Sepideh, Pourafkari, Leili, Ahmadi, Mojan, Chavoshi, Mohammad Reza, Zamani, Bijan, Nader, Nader D.
• Format: Journal Article
• Language: English
• Published: India Elsevier B.V 01-12-2018; Elsevier
• Subjects: Clinical and Preventive Cardiology; Coronary artery disease; Coronary Artery Disease - diagnosis; Coronary Artery Disease - physiopathology; Coronary Circulation - physiology; Coronary Vessels - diagnostic imaging; Cross-Sectional Studies; Electrocardiogram; Electrocardiography - methods; Female; Follow-Up Studies; Fragmented QRS; Humans; Male; Middle Aged; Myocardial perfusion imaging; Myocardial Perfusion Imaging - methods; Predictive Value of Tests; Prognosis; Prospective Studies; Risk Factors; Myocardial perfusion imaging; Fragmented QRS; Coronary artery disease; Electrocardiogram
• DOI: 10.1016/j.ihj.2018.09.011
• ISSN: 0019-4832

Fragmented QRS (FQRS) on surface electrocardiogram (ECG) is associated with the presence of myocardial scar tissue and may have prognostic value after certain ischemic events. We aimed to examine the anatomical correlation of FQRS with the presence of perfusion abnormalities in patients with suspected coronary artery disease (CAD).
Patients without a known history of CAD, who were referred for myocardial perfusion imaging (MPI) between January 2016 and May 2016, were enrolled. The presence of FQRS on surface ECG was evaluated. The presence of FQRS, number of leads with FQRS, and the location of FQRS as well as patient characteristics were compared in patients with normal versus abnormal MPI. Multivariate model was constructed to identify independent factors associated with perfusion defect.
One hundred four women and 94 men were enrolled. Fragmentation of anterior, lateral, and inferior leads was detected in 13 (6.5%), 17 (8.5%), and 36 (18.1%) subjects, respectively. MPI was normal in 134 (67.6%) patients. FQRS was significantly more common in patients with abnormal MPI (p < 0.001). Age (odds ratio [OR]: 1.05 [1.02–1.08]; p = 0.001), number of the leads presenting FQRS (OR: 1.46 [1.12–1.92] p = 0.006), and diabetes (OR: 2.33 [1.16–4.69]; p = 0.018) were independent predictors of the presence of perfusion defect on MPI.
In the absence of known CAD, FQRS is associated with the presence of perfusion abnormalities. Incorporating FQRS in diagnostic armamentarium may aid us in selecting patients who may benefit from MPI.