The fragmented QRS: does it really indicate a ventricular abnormality?
OBJECTIVE
Notching of R and S waves in the QRS complex can result from myocardial infarction. As defined in recent studies, the 'fragmented QRS' (fQRS) showed high sensitivity and specificity for the presence of myocardial scar as imaged by myocardial perfusion scanning in participants studied for ischemic heart disease. The present study attempted to determine the significance of the fQRS in electrocardiograms of patients who had myocardial imaging for a variety of reasons by a variety of methods.


METHODS
From a series of electrocardiograms, 218 patients were found with fQRS without abnormal Q waves, but with myocardial imaging by myocardial perfusion scanning or echocardiography. Another 214 patients without fQRS but having had one of these imaging methods were also studied. An additional 106 patients with or without fQRS were selected for having undergone cardiac magnetic resonance imaging with studies for late gadolinium enhancement.


RESULTS
Myocardial perfusion scanning, echocardiography, or magnetic resonance imaging revealed a ventricular myocardial abnormality in 52.6% of patients with fQRS and in 29.7% without fQRS (P < 0.0001). Ischemic heart disease was present in only 27% of patients showing fQRS. An electrocardiographic point score system was devised that helped to differentiate tracings having an fQRS with a ventricular abnormality from those without the latter.


CONCLUSIONS
The utility of fQRS varies with the incidence of ventricular disease in the population studied. This electrocardiographic sign is commonly associated with ventricular abnormalities with and without demonstrable myocardial scar, but also occurs in the absence of clinical heart disease.
MacAlpin
Rex N
RN
Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, California 90095-1679, USA. rex.macalpin@ucla.edu
D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D006352:Heart Ventricles / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D015141:Los Angeles; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D055414:Myocardial Perfusion Imaging; D009206:Myocardium / Q000473:pathology; D011237:Predictive Value of Tests; D015899:Tomography, Emission-Computed, Single-Photon; D016277:Ventricular Function, Left