title: The relation of fragmented QRS with tissue Doppler derived parameters in patients with b-thalassaemia major.
abstract: OBJECTIVE
  The most important complication encountered in patients with b-thalassaemia major is degenerative fibrosis developing as a result of iron accumulation in myocardial tissue. Dysfunction pursues this accumulation. Recently, presence of fragmented QRS (fQRS) in ECG has been regarded as a predictor of myocardial fibrosis. We aimed in our study to investigate the frequency with which fQRS develops in patients with b-thalassaemia major and to disclose the correlation between fQRS frequency and Doppler-derived indices.
  
  
  METHODS
  The patients with b-thalassaemia major (n=66; mean age: 23±6 years) and healthy controls (n=30; mean age: 23±4 years) were included. fQRS pattern was described as presence of RSR' manifested as existence of additional R wave and notching in either R or S waves in ECG recordings. 2D, M-mode, conventional Doppler, tissue Doppler echocardiography parameters were assessed. Mean serum ferritin levels over past 5 years were also calculated.
  
  
  RESULTS
  When compared to those in control group, fQRS was more frequent in b-thalassaemia major group, indicating statistical significance (p = 0.001). While E/Em and ferritin level exhibited statistically significant increase in thalassaemia patients with fQRS (p < 0.05), the mean Em and Sm values were found to be significantly low (p < 0.05).
  
  
  CONCLUSIONS
  fQRS was frequently observed in the patients with b-thalassaemia major, which was of statistical significance. Tissue Doppler-derived diastolic and systolic indices in thalassaemia cases with fQRS showed statistically significant impairment compared to those without fQRS. In conclusion, fQRS may represent a novel noninvasive marker for cardiac involvement in patients with b-thalassaemia major.
authors.affiliation: Mustafa Kemal University Faculty of Medicine, Department of Cardiology, Serinyol, Antakya, Turkey.
authors.forename: Eyup
authors.initials: E
authors.lastname: Buyukkaya
authors.forename: Mehmet Fatih
authors.initials: MF
authors.lastname: Karakas
authors.forename: Mustafa
authors.initials: M
authors.lastname: Kurt
authors.forename: Perihan
authors.initials: P
authors.lastname: Bilen
authors.forename: Fatih
authors.initials: F
authors.lastname: Yalcın
authors.forename: Murat
authors.initials: M
authors.lastname: Celik
authors.forename: Rami
authors.initials: R
authors.lastname: Helvacı
authors.forename: Hasan
authors.initials: H
authors.lastname: Kaya
authors.forename: Filiz
authors.initials: F
authors.lastname: Ertekin
authors.forename: Erdogan
authors.initials: E
authors.lastname: Sökmen
authors.forename: Nihat
authors.initials: N
authors.lastname: Sen
authors.forename: Adnan Burak
authors.initials: AB
authors.lastname: Akcay
mesh_terms: D016022:Case-Control Studies; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D005355:Fibrosis; D006321:Heart / Q000503:physiopathology; D006801:Humans; D008297:Male; D009206:Myocardium / Q000473:pathology*; D055815:Young Adult; D017086:beta-Thalassemia / Q000150:complications* / Q000473:pathology / Q000503:physiopathology