title: Fragmented QRS complexes are a marker of myocardial fibrosis in hypertensive heart disease.
abstract: OBJECTIVE
  Carboxy-terminal propeptide of type 1 procollagen (PICP) is a marker of extracellular collagen synthesis. Fragmented QRS (fQRS) on a 12-lead electrocardiogram (ECG) has been demonstrated as a marker of myocardial fibrosis. The present objective was to investigate the association between serum PICP concentration and presence of fQRS on ECG in hypertensive patients.
  
  
  METHODS
  Consecutive patients with previously or newly diagnosed hypertension were included. fQRS was defined as the presence of additional R-wave (R'), or notching of R- or S-waves, or the presence of fragmentation in 2 contiguous ECG leads. Serum PICP levels were measured by ELISA method.
  
  
  RESULTS
  The study group consisted of 90 hypertensive patients (74% females, with a mean age of 54.7±8.5 years). Of these patients, 47 (52.2%) had fQRS on ECG. Age (p=0.121) and gender distribution (p=0.625) were similar in patients with or without fQRS. Receiver operating characteristic curve analysis yielded a strong predictive ability of PICP levels for the presence of fQRS (area under the curve: 0.850; 95% CI: 0.772-0.929; p<0.0001). In multivariate logistic regression analysis, PICP levels were strongly and independently associated with the presence of fQRS (OR: 1.938; 95% CI: 1.398-2.688).
  
  
  CONCLUSIONS
  Serum PICP level is a strong and independent predictor of fQRS. Discriminative performance of serum PICP levels for the presence of fQRS is high. The present results are the first to demonstrate that fQRS may indicate myocardial fibrosis in patients with hypertension.
authors: Department of Cardiology, Hitit University Çorum Training and Research Hospital, Çorum, Turkey. lbb2006@gmail.com.
authors: Lütfü
authors: L
authors: Bekar
authors: Department of Medical Biochemistry, Tokat Government Hospital, Tokat, Turkey.
authors: Muzaffer
authors: M
authors: Katar
authors: Department of Cardiology, Hitit University Çorum Training and Research Hospital, Çorum, Turkey.
authors: Mücahit
authors: M
authors: Yetim
authors: Department of Cardiology, Hitit University Çorum Training and Research Hospital, Çorum, Turkey.
authors: Oğuzhan
authors: O
authors: Çelik
authors: Department of Cardiology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey.
authors: Hakan
authors: H
authors: Kilci
authors: Department of Cardiology, Karabük University Faculty of Medicine, Karabük, Turkey.
authors: Orhan
authors: O
authors: Önalan
mesh_terms: D015415:Biomarkers / Q000097:blood; D009202:Cardiomyopathies / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D005355:Fibrosis / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D006973:Hypertension; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000097:blood*; D011347:Procollagen / Q000097:blood*; D012372:ROC Curve
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D011347:Procollagen; C042813:procollagen type I carboxy terminal peptide