title: Fragmented QRS on surface electrocardiogram is not a reliable predictor of myocardial scar, angiographic coronary disease or long term adverse outcomes.
abstract: OBJECTIVE
  Conflicting evidence remains regarding the value of fragmented QRS (fQRS) on surface electrocardiogram (EKG). We present the 5-year outcome of patients with fQRS on EKG and its correlation to SPECT and coronary angiography (CA).
  
  
  METHODS
  We retrospectively studied EKG's in 248 consecutive patients undergoing SPECT and CA with known or suspected coronary artery disease (CAD). The presence of fQRS or Q waves in two contiguous EKG leads was correlated with major coronary artery distributions on SPECT and cath. Patients with bundle-branch block, paced-rhythm or absence of EKG within one month of SPECT were excluded. The final EKG data for 238 patients were analyzed and compared with myocardial scar on SPECT and the presence of significant (>50%) coronary stenosis on CA. Predictors of MACE (death, MI, heart failure) were evaluated. Freedom from all-cause mortality was assessed by Kaplan-Meier analysis.
  
  
  RESULTS
  Of 238 patients, no significant difference was noted in the presence of scar on SPECT in fQRS (3/77; 3.8%) versus no fQRS (11/161; 6.8%) (P=0.56); or CA based CAD (55/77; 71% fQRS) and no fQRS (99/161, 61.4%) (P=0.20). EKG Q wave presence was similar in both groups: (12/77; 15.5% fQRS), (17/161; 10.5% no fQRS) (P=0.3). Patients with CA based significant LAD disease were 3.680 times more likely to have fQRS (P=0.04), however, fQRS was not significantly associated with MACE (P=0.92) or all-cause mortality (P=0.93).
  
  
  CONCLUSIONS
  This study does not support routine assessment of fQRS on surface EKG as a reliable predictor of SPECT myocardial scar, MACE or all-cause mortality over a long period of follow-up.
authors.affiliation: 1 Henry Ford Hospital, Heart and Vascular Institute, Detroit, MI, USA ; 2 Cardiovascular Physicians of North Atlanta, Roswell, Georgia.
authors.forename: Dee Dee
authors.initials: DD
authors.lastname: Wang
authors.affiliation: 1 Henry Ford Hospital, Heart and Vascular Institute, Detroit, MI, USA ; 2 Cardiovascular Physicians of North Atlanta, Roswell, Georgia.
authors.forename: Amit
authors.initials: A
authors.lastname: Tibrewala
authors.affiliation: 1 Henry Ford Hospital, Heart and Vascular Institute, Detroit, MI, USA ; 2 Cardiovascular Physicians of North Atlanta, Roswell, Georgia.
authors.forename: Phuc
authors.initials: P
authors.lastname: Nguygen
authors.affiliation: 1 Henry Ford Hospital, Heart and Vascular Institute, Detroit, MI, USA ; 2 Cardiovascular Physicians of North Atlanta, Roswell, Georgia.
authors.forename: Tanmay
authors.initials: T
authors.lastname: Swadia
authors.affiliation: 1 Henry Ford Hospital, Heart and Vascular Institute, Detroit, MI, USA ; 2 Cardiovascular Physicians of North Atlanta, Roswell, Georgia.
authors.forename: Gordon
authors.initials: G
authors.lastname: Jacobsen
authors.affiliation: 1 Henry Ford Hospital, Heart and Vascular Institute, Detroit, MI, USA ; 2 Cardiovascular Physicians of North Atlanta, Roswell, Georgia.
authors.forename: Arfaat
authors.initials: A
authors.lastname: Khan
authors.affiliation: 1 Henry Ford Hospital, Heart and Vascular Institute, Detroit, MI, USA ; 2 Cardiovascular Physicians of North Atlanta, Roswell, Georgia.
authors.forename: Karthik
authors.initials: K
authors.lastname: Ananthasubramaniam
keywords: Fragmented QRS (fQRS); coronary angiography (CA); single-photon emission computed tomography (SPECT)