QRS-Fragmentation: Perspectives for Use in Clinical Practice

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Abstract

The current article provides a detail review of foreign publications, discussing the opportunities and the benefits of evaluation of the QRS-fragmentation (fQRS) — a new electrocardiographic (ECG) parameter in patients with coronary artery disease (CAD). Diagnostic criteria for narrow and wide QRS-complexes are defined. Main results of the comparative and correlation analysis, evaluating fQRS and electrocardiographic (pathologic Q-waves), echocardiographic (left ventricular ejection fraction), angiographic settings are described. There is a discussion of the prognostic role of fQRS in stable CAD as well as in patients presented with acute myocardial infarction. fQRS is an available ECG-marker of local myocardial fibrosis. It seems to be a useful negative predictor in individuals with CAD, indicating an increased risk of life-threatening ventricular arrhythmias and recurrent cardiac events. The presence of fragmented QRS-complexes is associated with an increased in-hospital and long term (overall as well as cardiovascular) mortality. Routine evaluation of fQRS in standard ECG leads does not require additional resources, and will contribute to an improvement in diagnostics and risk stratification of stable CAD as well as myocardial infarction. Assessment of fQRS can be included in noninvasive diagnostic algorithm concerning CAD.

About the authors

Yuri N. Fedulaev

Pirogov Russian National Research Medical University

Email: kuwert@yandex.ru
ORCID iD: 0000-0003-4040-2971
SPIN-code: 2764-7250

MD, PhD, Professor, Head of the Department of Faculty Therapy

Russian Federation, 1 Ostrovitianov street, Moscow, 117997

Irina V. Makarova

Pirogov Russian National Research Medical University

Author for correspondence.
Email: irina-makarova93@mail.ru
ORCID iD: 0000-0001-5127-1300
SPIN-code: 3525-1775
ResearcherId: ABE-1969-2020

assistant, Department of Faculty Therapy

Russian Federation, 1 Ostrovitianov street, Moscow, 117997

Tatiana V. Pinchuk

Pirogov Russian National Research Medical University

Email: doktor2000@inbox.ru
ORCID iD: 0000-0002-7877-4407
SPIN-code: 1940-2017

MD, PhD, Department of Faculty Therapy

Russian Federation, 1 Ostrovitianov street, Moscow, 117997

Grigoriy A. Chuvarayan

Pirogov Russian National Research Medical University; City Clinical Hospital №13

Email: grigoriy.chuvarayan@gmail.com
ORCID iD: 0000-0002-4503-6280
SPIN-code: 1333-2511

MD, PhD; Head of Department of X-ray endovascular diagnosis and treatment

Russian Federation, 1 Ostrovitianov street, Moscow, 117997; 1/1 Velozavodskaja street, Moscow, 115280

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Supplementary files

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1. JATS XML
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2. Fig. 1. Variants of fragmented narrow (A – B) and wide (D) QRS complexes

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3. Fig. 2. Fragmentation of QRS complexes along the lower wall of the left ventricle (QRS complexes of the RSR´ type in standard lead III, split R waves - in lead aVF)

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4. Fig. 3. Fragmented QRS complexes in the chest leads in a patient with multivessel coronary artery disease: V4 - S-wave notch; V5-6 - R-wave splitting; writing speed - 50 mm / s

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