title: The Predictive Value of Admission Fragmented QRS Complex for In-Hospital Cardiovascular Mortality of Patients with Type 1 Acute Aortic Dissection.
abstract: BACKGROUND
  Fragmented QRS (fQRS) arises from impaired ventricular depolarization due to heterogeneous electrical activation of ischemic and/or infarcted ventricular myocardium. The short- and long-term prognostic values of fQRS have been reported for myocardial infarction, heart failure, fatal cardiac arrhythmias, and sudden cardiac death. The aim of this study was to investigate the predictive value of admission fQRS complex for in-hospital cardiovascular mortality of patients with type 1 acute aortic dissection (AAD).
  
  
  METHODS
  In this retrospective study, 203 consecutive patients with type 1 AAD who had been admitted to either of two large-volume tertiary hospitals between December 2008 and October 2013 were included. The patients were divided into two groups according to the presence or absence of the fQRS complex on admission.
  
  
  RESULTS
  In-hospital cardiovascular mortality (P < 0.001), major adverse cardiovascular events (P < 0.001), acute renal failure (P = 0.022), multiorgan dysfunction (P < 0.001), and acute decompensated heart failure (P < 0.001) were observed to be significantly more frequent in the fQRS-positive group than in the fQRS-negative group. fQRS (odds ratio [95% confidence interval]: 4.184 [1.927-9.082], P < 0.001), operation duration (4.184 [1.927-9.082], P = 0.001), and Killip class IV (3.900 [1.699-8.955], P = 0.001) were found to be significant independent predictors of in-hospital cardiovascular mortality after adjustment of other risk factors in the multivariate analysis.
  
  
  CONCLUSIONS
  fQRS is a simple, inexpensive, and readily available electrocardiographic entity that provides an additional risk stratification level beyond that provided by conventional risk parameters in predicting in-hospital cardiovascular mortality in type 1 AAD.
authors.affiliation: Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Training Hospital, Istanbul, Turkey.
authors.forename: Ali Kemal
authors.initials: AK
authors.lastname: Kalkan
authors.affiliation: Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Training Hospital, Istanbul, Turkey.
authors.forename: Huseyin Altug
authors.initials: HA
authors.lastname: Cakmak
authors.affiliation: Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey.
authors.forename: Mehmet Emin
authors.initials: ME
authors.lastname: Kalkan
authors.affiliation: Department of Cardiovascular Surgery, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey.
authors.forename: Mehmet Altug
authors.initials: MA
authors.lastname: Tuncer
authors.affiliation: Department of Cardiovascular Surgery, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey.
authors.forename: Ebuzer
authors.initials: E
authors.lastname: Aydin
authors.affiliation: Department of Cardiovascular Surgery, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey.
authors.forename: Mehmed
authors.initials: M
authors.lastname: Yanartas
authors.affiliation: Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Training Hospital, Istanbul, Turkey.
authors.forename: Muhammet Hulusi
authors.initials: MH
authors.lastname: Satilmisoglu
authors.affiliation: Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Training Hospital, Istanbul, Turkey.
authors.forename: Hale Unal
authors.initials: HU
authors.lastname: Aksu
authors.affiliation: Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Training Hospital, Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Erturk
authors.affiliation: Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Training Hospital, Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Gul
authors.affiliation: Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey.
authors.forename: Ugur
authors.initials: U
authors.lastname: Arslantas
authors.affiliation: Department of Cardiovascular Surgery, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey.
authors.forename: Mehmet Kaan
authors.initials: MK
authors.lastname: Kirali
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000175:diagnosis* / Q000401:mortality*; D001014:Aortic Aneurysm / Q000150:complications / Q000175:diagnosis* / Q000401:mortality*; D002318:Cardiovascular Diseases / Q000401:mortality; D016022:Case-Control Studies; D004562:Electrocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment
keywords: acute aortic dissection; cardiovascular mortality; electrocardiography; fragmented QRS