title: The independent relationship between systemic inflammation and fragmented QRS complexes in patients with stable angina pectoris.
abstract: BACKGROUND
  QRS complex fragmentations can frequently be seen on routine ECG with narrow or wide QRS complex. Fragmented QRS complexes (fQRS) are defined as various RSR' patterns (≥ 1 R' or notching of S wave or R wave) in two contiguous leads corresponding to a major coronary artery territory. In previous studies, fQRS has been associated with increased morbidity and mortality, sudden cardiac death and recurrent cardiovascular events. The causative relationship between fQRS and cardiac fibrosis has been shown, but it has not been extensively studied whether there are different mechanisms for the development of fQRS AIM: To interrogate the relationship between systemic inflammation and the presence of fQRS in patients with stable angina pectoris.
  
  
  METHODS
  A total of 353 eligible patients who underwent coronary angiography with a suspicion of coronary artery disease (CAD) at our institution between April 2010 and December 2010 were enrolled consecutively. All patients had angina pectoris or angina equivalent symptoms with either a positive treadmill test or myocardial perfusion study. Patients with recent acute coronary syndrome either with or without ST-segment elevation, significant organic valve disease, and patients having any QRS morphology with QRS duration ≥ 120 ms, as well as patients with permanent pacemakers, were excluded from the study.
  
  
  RESULTS
  Patients with fQRS had older age (p = 0.01), higher C-reactive protein (CRP) (p 〈 0.001), longer QRS time (p 〈 0.001) and more severe CAD (p 〈 0.001) compared to patients with non-fragmented QRS. When we performed multiple logistic regression analysis, we found that the fragmentations in QRS complexes were positively related with increased CRP (OR: 3.8, 95% CI 1.573.9.278, p = 0.003), and QRS duration (OR: 1.1, 95% CI 1.008.1.101, p = 0.019) and negatively related with left ventricular ejection fraction [%] (OR: 1.0, 95% CI 0.914.0.992, p = 0.020).
  
  
  CONCLUSIONS
  In our study, we found that fQRS was independently related with increased CRP and QRS duration as well as left ventricular systolic dysfunction. Fragmented QRS, which may come about as an end effect of inflammation at cellular level, can represent increased cardiac risk by different causative mechanisms in patients with stable CAD. In addition, fragmentations on ECG may be useful for identifying patients who should be investigated and treated for their increased inflammatory status and possible chronic infections.
authors: Rize Education and Research Hospital, Department of Cardiology, Rize, Turkey.
authors: Mustafa
authors: M
authors: Cetin
authors: Sinan Altan
authors: SA
authors: Kocaman
authors: Aytun
authors: A
authors: Canga
authors: M Emre
authors: ME
authors: Durakoglugil
authors: Turan
authors: T
authors: Erdogan
authors: Omer
authors: O
authors: Satiroglu
authors: Tuncay
authors: T
authors: Kiris
authors: Yavuz
authors: Y
authors: Ugurlu
authors: Yuksel
authors: Y
authors: Cicek
authors: Mehmet
authors: M
authors: Bostan
mesh_terms: D060050:Angina, Stable / Q000175:diagnosis* / Q000453:epidemiology*; D015984:Causality; D002908:Chronic Disease; D015897:Comorbidity; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000453:epidemiology; D003430:Cross-Sectional Studies; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007249:Inflammation / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged