Relationship between fragmented QRS and no-reflow, infarct size, and peri-infarct zone assessed using cardiac magnetic resonance in patients with myocardial infarction.
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.
Department of Cardiology, University Hospital, Dijon, France; Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, University of Burgundy, Dijon, France. Electronic address: luc.lorgis@chu-dijon.fr.
Luc
L
Lorgis
MRI Unit and LE2I UMR CNRS 6306, University Hospital, Dijon, France.
Alexandre
A
Cochet
MRI Unit and LE2I UMR CNRS 6306, University Hospital, Dijon, France.
Olivier
O
Chevallier
Department of Cardiology, University Hospital, Dijon, France.
Marion
M
Angue
Department of Cardiology, University Hospital, Dijon, France; Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, University of Burgundy, Dijon, France.
Aurelie
A
Gudjoncik
MRI Unit and LE2I UMR CNRS 6306, University Hospital, Dijon, France.
Alain
A
Lalande
Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, University of Burgundy, Dijon, France.
Marianne
M
Zeller
Department of Cardiology, University Hospital, Dijon, France.
Philippe
P
Buffet
MRI Unit and LE2I UMR CNRS 6306, University Hospital, Dijon, France.
François
F
Brunotte
Department of Cardiology, University Hospital, Dijon, France; Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, University of Burgundy, Dijon, France.
Yves
Y
Cottin
D000368:Aged; D018450:Disease Progression; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology*; D020257:Ventricular Remodeling