Relationship Between Fragmented QRS and No-Reflow, Infarct Size, and Peri-Infarct Zone Assessed Using Cardiac Magnetic Resonance in Patients With Myocardial Infarction

• Published in: Canadian journal of cardiology Vol. 30; no. 2; pp. 204 - 210
• Main Authors: Lorgis, Luc, MD, PhD, Cochet, Alexandre, MD, PhD, Chevallier, Olivier, MD, Angue, Marion, MD, Gudjoncik, Aurelie, MD, Lalande, Alain, PhD, Zeller, Marianne, PhD, Buffet, Philippe, MD, Brunotte, François, MD, PhD, Cottin, Yves, MD, PhD
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01.02.2014; Elsevier
• Subjects: Aged; Bioengineering; Cardiovascular; Disease Progression; Electrocardiography; Female; Follow-Up Studies; Humans; Life Sciences; Magnetic Resonance Imaging, Cine - methods; Male; Middle Aged; Myocardial Infarction - complications; Myocardial Infarction - diagnosis; Myocardial Infarction - physiopathology; Nuclear medicine; Prognosis; Prospective Studies; Severity of Illness Index; Stroke Volume; Ultrasonography; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - etiology; Ventricular Dysfunction, Left - physiopathology; Ventricular Function, Left - physiology; Ventricular Remodeling
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/j.cjca.2013.11.026

Abstract Background The relation between fragmented QRS complex (fQRS) and cardiac magnetic resonance parameters is poorly documented in ischemic cardiopathy. Methods Among 209 consecutive patients, those with fQRS were compared with those without fQRS. Cardiac magnetic resonance studies with late gadolinium-enhanced sequences were done during the week after acute myocardial infarction. Results fQRS was present in 113 (54%) patients, and associated with a significantly lower left ventricular ejection fraction, increased left ventricular volumes, a larger infarct size (IS), and a larger peri-infarct zone. Microvascular obstruction was more frequent in patients with fQRS (62% vs 45%; P  = 0.014) and the extent of the microvascular obstruction was significantly larger (1.6% [range, 0.0-4.4] vs 0.0 [range, 0.0-2.1]; P  = 0.004). Finally, the transmurality score in the 2 study populations was identical (48% vs 47%; P  = 0.895). In multivariate logistic regression analysis, only IS (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.03-1.09; P < 0.001), systolic blood pressure (OR, 1.02; 95% CI, 1.01-1.04; P < 0.001), and left ventricular end-systolic volume (OR, 1.02; 95% CI, 1.00-1.03; P  = 0.013) remained independent predictors of fQRS. Conclusions This study revealed that fQRS was associated with increased IS, myocardial perfusion abnormalities, decreased left ventricular ejection fraction, and increased left heart volumes. These findings show that fQRS is a reliable marker of infarct size and acute ventricular remodelling.