Fragmented Qrs Wave For The Evaluation Of Ischemic Cardiomyopathy In Patients With Ventricular Synchronicity

Objective: To investigate the relationship between fragmented QRS complexes andintraventricular dyssynchrony in patients with nonischemic cardiomyopathy in sinusrhythm.Methods: The present study was conducted in the Inpatient and OutpatientDepartment of Cardiology in First Affiliated Hospital of Suzhou University. sixty-fourpatients were consecutively recruited,thirty-seven males, twenty-seven females, with amean age of53.2±14.4years. All patients meet the following requirements: Leftventricular ejection fraction of less than45%and sinus rhythm having narrow (less than120ms) QRS complexes. Coronary angiography was performed for all patients in orderto exclued ischemic etiology of dilated cardiomyopathy. patients with organic valvularheart disease, history of myocardial infarction, ischemic electrocardiogramfinding,angiographically significant coronary artery disease (>50stenosis in anyepicardial coronary artery), persistent atrial fibrillation, frequent ventricular、atrial orjunctional premature contraction and other arrhythmia, permanent pacemakers wereexcluded from the study. Patients were categorized into2subgroups according to theirbasal ECGs: Group A was the fragmented QRS group, twenty-two person, thirteen malesand nine females with mean age55.1±14.3years; Group B was nonfragmented QRSgroup, forty-two patients, twenty-four males and eighteen females with mean age52.0±14.1years, who did not have fragmented QRS complexs in their restingelectrocardiogram. All patients was evaluated carefully for their left ventricularsynchronization by Tissue Doppler Inaging, Significant systolic dyssynchrony wasdefined as a Ts-TD>32.6ms accroding to Yu et al study previously. We observed thedifferent of intraventricular synchrony of two groups and investigated the association off-QRS and maximal dyssynchronic segment or one of the dyssynchronic segment.Results: There were seventeen patients (76%) with f-QRS complexes had significant LV dyssynchrony in Group A, five patients (24%) did not have LVdyssynchrony,only six patients (14%) in Group B had significant LV dyssynchrony,thrity-six patients (86%) did not have LV dyssynchrony guided by Tissue DopplerInaging.there was statistically significant diffierence between the two groups (P<0.0001).The presence of f-QRS complexes in the basal ECG in patients with nonischemiccardiomyopathy was found to detect intraventricular dyssynchrony with74%sensitivity,88%specificity, a positive predictive value of77%and a negative predictive value of86%. Among seventeen patients with significant intraventricular dyssynchrony onechocardiography in Group A,thirteen patients (76%,13/17) had ECG fragmentation inthe maximal dyssynchronic segment or one of the dyssynchronic segment.Conclusion:1. Fragmented QRS complexes is very common in nonischemiccardiomyopathy, often appears in inferior leads.2. Fragmented QRS complexes in basalECG is a simple and convenient index to predict intraventricular dyssynchrony innonischemic cardiomyopathy patients with a narrow QRS interval and sinus rhythm. Ithas high sensitivity and specificity.3. The leads of fragmented QRS complexes in basalECG often indicate the maximal dyssynchronic segment or one of the dyssynchronicsegment.