title: Fragmented QRS Complex Predicts In-Hospital Adverse Events and Long-Term Mortality in Patients with Acute Pulmonary Embolism.
abstract: BACKGROUND
  Electrocardiographic (ECG) abnormalities in pulmonary embolism (PE) are increasingly reported, and mounting data have recommended that ECG plays a crucial role in the prognostic assessment of PE patient population. However, there is scarce data on the prognostic importance of fragmented QRS (fQRS) on short- and long-term outcomes in patients with PE. Therefore, we aimed to investigate the prognostic role of fQRS in predicting in-hospital and long-term adverse outcomes in PE patients.
  
  
  METHODS
  A total of 249 patients (155 female, 66.2%; mean age, 66.0 ± 16.0) with the diagnosis of acute PE were enrolled and followed-up during median 24.8 months.
  
  
  RESULTS
  Compared with the fQRS (-) patient group, patients with fQRS showed higher rates of in-hospital adverse events including cardiogenic shock, the necessity of thrombolytic therapy, and in-hospital mortality as well as long-term all-cause mortality. In Kaplan-Meier survival analysis, during follow-up, all-cause mortality occurred more frequently in the fQRS (+) group (log-rank, P = 0.002). In multivariate Cox regression analysis, adjusted with other relevant parameters, the presence of fQRS were determined as an independent predictor of in-hospital adverse events (HR: 2.743, 95% CI: 1.267-5.937, P = 0.003) and long-term all-cause mortality (HR: 3.137, 95% CI: 1.824-6.840, P = 0.001).
  
  
  CONCLUSIONS
  The presence of fQRS complex, as a simple and feasible ECG marker, seems to be a novel predictor of in-hospital adverse events and long-term all-cause mortality in PE patient population. This parameter may utilize the identification of patients whom at higher risk for mortality and individualization of therapy.
authors.affiliation: Cardiology Department, Türkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey.
authors.forename: Mehmet Serkan
authors.initials: MS
authors.lastname: Cetin
authors.affiliation: Cardiology Department, Türkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey.
authors.forename: Elif Hande
authors.initials: EH
authors.lastname: Ozcan Cetin
authors.affiliation: Cardiology Department, Türkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey.
authors.forename: Fazil
authors.initials: F
authors.lastname: Arisoy
authors.affiliation: Cardiology Department, Türkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey.
authors.forename: Mevlüt Serdar
authors.initials: MS
authors.lastname: Kuyumcu
authors.affiliation: Cardiology Department, Türkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey.
authors.forename: Serkan
authors.initials: S
authors.lastname: Topaloglu
authors.affiliation: Cardiology Department, Türkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey.
authors.forename: Dursun
authors.initials: D
authors.lastname: Aras
authors.affiliation: Cardiology Department, Türkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Temizhan
mesh_terms: D000368:Aged; D000792:Angiography; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed
keywords: acute pulmonary embolism; fragmented QRS; prognosis; right ventricular dysfunction