title: Fragmented QRS complexes are associated with cardiac fibrosis and significant intraventricular systolic dyssynchrony in nonischemic dilated cardiomyopathy patients with a narrow QRS interval.
abstract: BACKGROUND
  Myocardial scar causes heterogeneous ventricular activation, which results in fragmentation of QRS complexes on ECG. Myocardial fibrosis in patients with nonischemic cardiomyopathy (NDCM) can be identified as late gadolinium enhancement (LGE) areas on cardiac magnetic resonance (CMR) studies. We investigated the association of fragmented QRS (fQRS) complexes with systolic dyssynchrony and myocardial fibrosis in patients with NDCM.
  
  
  METHODS
  Twenty patients with NDCM and sinus rhythm who had fQRS complexes were evaluated with CMR. The association of fQRS complexes with LGE and systolic dyssynchrony was investigated.
  
  
  RESULTS
  Nineteen patients had significant systolic dyssynchrony with echocardiography. Among 19 patients with significant dyssynchrony, 14 (74%) patients had fQRS complexes in the most delayed contracting segment or one of the dyssynchronous segments, whereas five patients (26%) had fQRS complexes in a lead which is discordant with the dyssynchronous segment on echocardiography. Seventeen patients had LGE in their CMR. Among the 17 patients with LGE; 13 patients (76%) had fQRS complexes concordant with LGE present segments.
  
  
  CONCLUSIONS
  Fragmentation of QRS complexes on ECG is associated with intraventricular systolic dyssynchrony and subendocardial fibrosis in NDCM patients with a narrow QRS interval and sinus rhythm.
authors.affiliation: Cardiology Department, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey. mktigen@yahoo.com
authors.forename: Yelda
authors.initials: Y
authors.lastname: Basaran
authors.forename: Kursat
authors.initials: K
authors.lastname: Tigen
authors.forename: Tansu
authors.initials: T
authors.lastname: Karaahmet
authors.forename: Iclal
authors.initials: I
authors.lastname: Isiklar
authors.forename: Cihan
authors.initials: C
authors.lastname: Cevik
authors.forename: Emre
authors.initials: E
authors.lastname: Gurel
authors.forename: Cihan
authors.initials: C
authors.lastname: Dundar
authors.forename: Selcuk
authors.initials: S
authors.lastname: Pala
authors.forename: Kamran
authors.initials: K
authors.lastname: Mahmutyazicioglu
authors.forename: Ozcan
authors.initials: O
authors.lastname: Basaran
mesh_terms: D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D004452:Echocardiography / Q000379:methods*; D004719:Endomyocardial Fibrosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000000981:diagnostic imaging; D018810:Magnetic Resonance Angiography; D008297:Male; D011859:Radiography; D018754:Ventricular Dysfunction / Q000175:diagnosis / Q000000981:diagnostic imaging*