title: Fragmented QRS Is Associated with Improved Predictive Value of Exercise Treadmill Testing in Patients with Intermediate Pretest Likelihood of Significant Coronary Artery Disease.
abstract: BACKGROUND
  The predictive value of exercise treadmill testing (ETT) remains inadequate in diagnosing patients with suspected coronary artery disease (CAD) and needs to be improved.
  
  
  OBJECTIVE
  The aim of this study was to investigate whether the presence of FQRS on 12-lead ECG would increase the PPV of ETT in patients with an intermediate likelihood of CAD.
  
  
  METHODS
  fQRS, defined as the presence of notched R or S waves without accompanying typical bundle branch block or the existence of an additional wave-like RSR' pattern in the original QRS complex (with a duration of <120 ms), was assessed in 95 patients with positive ETT. Coronary angiogram (CA) was performed in all patients, divided into two groups as the significant CAD group and nonsignificant CAD group according to coronary artery lesions. The differences between the groups in terms of the presence of fQRS and clinical characteristics were investigated.
  
  
  RESULTS
  The mean age of patients was 51.3 ± 11.3 years, and 74 of them were males (77.9%). FQRS was present in 47 (49.5%) patients, and significant CAD was demonstrated in 51 subjects (53.7%) among the enrolled subjects. fQRS was more prevalent in the significant CAD group compared to nonsignificant CAD group (P < 0.001). The presence of FQRS increased the PPV of positive ETT from 53.7% to 85.1%. In addition, FQRS was associated with the increased risk of significant CAD in multivariate analysis (OR = 2.839, P < 0.001).
  
  
  CONCLUSIONS
  In clinical practice, the presence of fQRS in patients with positive ETT may support clinicians during the decision-making process with regard to the referral for a coronary angiography.
authors.affiliation: Department of Cardiology, Sanliurfa Mehmet Akif Inan Training and Research Hospital, Sanliurfa, Turkey.
authors.forename: Eyyup
authors.initials: E
authors.lastname: Tusun
authors.affiliation: Department of Cardiology, Sanliurfa Mehmet Akif Inan Training and Research Hospital, Sanliurfa, Turkey.
authors.forename: Abdulselam
authors.initials: A
authors.lastname: Ilter
authors.affiliation: Department of Cardiology, Sanliurfa Mehmet Akif Inan Training and Research Hospital, Sanliurfa, Turkey.
authors.forename: Feyzullah
authors.initials: F
authors.lastname: Besli
authors.affiliation: Department of Cardiology, Harran University School of Medicine, Sanliurfa, Turkey.
authors.forename: Emre
authors.initials: E
authors.lastname: Erkus
authors.affiliation: Department of Cardiology, Harran University School of Medicine, Sanliurfa, Turkey.
authors.forename: Ibrahim Halil
authors.initials: IH
authors.lastname: Altiparmak
authors.affiliation: Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Bozbay
mesh_terms: D003324:Coronary Artery Disease / Q000175:diagnosis*; D004562:Electrocardiography / Q000379:methods*; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012307:Risk Factors
keywords: coronary artery disease; exercise stress test; fragmented QRS