Abstract
Recovery of left ventricular ejection fraction (LVEF) after acute myocardial infarction (MI) is not universal and is difficult to predict. Fragmented QRS (fQRS) complexes are thought to be markers of myocardial scar. We hypothesized that fQRS complexes on 12‑lead surface ECGs during the initial post-MI period would be associated with adverse LV remodeling over the following year. Change in LVEF between the early (0-2 month) and later (2-12 month) post-MI periods was assessed in two independent cohorts of post-MI patients with initial LV dysfunction. A decline or no recovery in LVEF (ΔLVEF ≤0%) was used as a primary outcome. fQRS complexes were measured on 12‑lead ECGs within a week of acute MI. A subset of patients underwent cardiac magnetic resonance imaging (CMR) for scar quantification. Of 705 patients in the combined cohort, 27% experienced the primary outcome (average ΔLVEF of -4%). fQRS complexes were associated with a two-fold higher risk of no LVEF recovery, independent of prior MI or CABG, baseline LVEF, MI location and QRS duration or axis. Of 113 patients undergoing CMR, fQRS was associated with increased peri-infarct zone late gadolinium enhancement (13 ± 5% vs 11 ± 4%, p = 0.02), but not core infarct. Despite conte...Continue Reading
References
Aug 11, 1983·The New England Journal of Medicine·UNKNOWN Multicenter Postinfarction Research Group
Mar 20, 2001·Annals of Internal Medicine·S D SolomonM A Pfeffer
Jun 22, 2005·Circulation·Scott D SolomonMarc A Pfeffer
Aug 2, 2005·The American Journal of Cardiology·Amir HalkinAlexandra J Lansky
May 24, 2006·Circulation·Mithilesh K DasJo Mahenthiran
Jun 28, 2006·Circulation·Andrew T YanRaymond Y Kwong
Mar 17, 2007·Scandinavian Cardiovascular Journal : SCJ·Erik HedströmHåkan Arheden
Jul 10, 2007·Journal of the American College of Cardiology·Gjin NdrepepaAdnan Kastrati
Oct 24, 2007·Circulation·Kristian ThygesenNawwar Al-Attar
Dec 11, 2007·Journal of the American College of Cardiology·Derek V ExnerUNKNOWN REFINE Investigators
Jan 4, 2008·Circulation·Paolo G CamiciOrnella E Rimoldi
Mar 14, 2009·Journal of the American College of Cardiology·Borys SurawiczUNKNOWN Heart Rhythm Society
Oct 8, 2009·Circulation. Arrhythmia and Electrophysiology·Mithilesh K DasJo Mahenthiran
Feb 5, 2010·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Mithilesh Kumar DasDeepak Bhakta
Jun 12, 2010·Journal of the American College of Cardiology·Shahriar HeidaryPhillip C Yang
Jul 14, 2010·Heart Failure Reviews·Jason J Gajarsa, Robert A Kloner
Nov 11, 2010·Heart·Jonas HallénDan Atar
Feb 19, 2011·JACC. Cardiovascular Imaging·Andrew S FlettJames C Moon
May 11, 2012·Circulation. Cardiovascular Imaging·Peng GaoJames A White
Oct 8, 2013·American Heart Journal·Amy Leigh MillerTracy Y Wang
Jan 28, 2014·The Canadian Journal of Cardiology·Luc LorgisYves Cottin
Jul 28, 2016·JACC. Cardiovascular Imaging·Marcello DisertoriFlavia Ravelli
Jul 28, 2016·JACC. Cardiovascular Imaging·Kenneth C Bilchick
Jun 24, 2017·Circulation. Cardiovascular Imaging·Katherine C Wu
Apr 15, 2018·American Heart Journal·Derek S ChewUNKNOWN APPROACH Investigators
Citations
Mar 14, 2020·Coronary Artery Disease·Hayati ErenAdnan Abaci
May 28, 2020·Herz·Mohammad Reza DehghaniYousef Rezaei
Feb 26, 2021·Clinical and Experimental Hypertension : CHE·Ali Rıza AkyüzHakan Erkan