BACKGROUND: Cardiac resynchronization therapy is an important therapeutic modality in drug refractory symptomatic patients of heart failure with wide QRS (≥120 ms) on electrocardiogram. However, wide QRS (considered as a marker of electrical dyssynchrony) occurs in only 30% of heart failure patients, making majority of drug refractory heart failure patients ineligible for resynchronization therapy. Significant numbers of patients with narrow QRS have echocardiographic evidence of left ventricular dyssynchrony. However, there is sparse data about additional features on the surface ECG which can predict intraventricular dyssynchrony. This study was undertaken to assess the utility of fragmented narrow QRS complex to predict significant intraventricular dyssynchrony in symptomatic patients of non-ischemic dilated cardiomyopathy. METHOD: 100 symptomatic patients of non-ischemic dilated cardiomyopathy with narrow QRS complexes (50 each with fragmented and normal QRS) were recruited. Tissue Doppler imaging was used to assess intraventricular dyssynchrony as per 'Yu index'. RESULTS: 78% patients (n = 39) in fQRS complex group and 14% (n = 7) in normal QRS complex group had significant intraventricular dyssynchrony (χ(2) = 20.61; p < 0.000005). fQRS complexes had 84.78% sensitivity, 79.62% specificity, a positive predictive value of 78% and negative predictive value of 86% to detect intraventricular dyssynchrony. fQRS also had sensitivity and specificity of 93% and 90% respectively to localize the dyssynchronous segment. CONCLUSION: fQRS is a marker of electrical dyssynchrony, which results in significant intraventricular dyssynchrony in patients of non-ischemic dilated cardiomyopathy and a narrow QRS interval. fQRS localizes the dyssynchronous segment and might be useful in identifying patients who can benefit from cardiac resynchronization therapy.
BACKGROUND: Cardiac resynchronization therapy is an important therapeutic modality in drug refractory symptomatic patients of heart failure with wide QRS (≥120 ms) on electrocardiogram. However, wide QRS (considered as a marker of electrical dyssynchrony) occurs in only 30% of heart failurepatients, making majority of drug refractory heart failurepatients ineligible for resynchronization therapy. Significant numbers of patients with narrow QRS have echocardiographic evidence of left ventricular dyssynchrony. However, there is sparse data about additional features on the surface ECG which can predict intraventricular dyssynchrony. This study was undertaken to assess the utility of fragmented narrow QRS complex to predict significant intraventricular dyssynchrony in symptomatic patients of non-ischemic dilated cardiomyopathy. METHOD: 100 symptomatic patients of non-ischemic dilated cardiomyopathy with narrow QRS complexes (50 each with fragmented and normal QRS) were recruited. Tissue Doppler imaging was used to assess intraventricular dyssynchrony as per 'Yu index'. RESULTS: 78% patients (n = 39) in fQRS complex group and 14% (n = 7) in normal QRS complex group had significant intraventricular dyssynchrony (χ(2) = 20.61; p < 0.000005). fQRS complexes had 84.78% sensitivity, 79.62% specificity, a positive predictive value of 78% and negative predictive value of 86% to detect intraventricular dyssynchrony. fQRS also had sensitivity and specificity of 93% and 90% respectively to localize the dyssynchronous segment. CONCLUSION: fQRS is a marker of electrical dyssynchrony, which results in significant intraventricular dyssynchrony in patients of non-ischemic dilated cardiomyopathy and a narrow QRS interval. fQRS localizes the dyssynchronous segment and might be useful in identifying patients who can benefit from cardiac resynchronization therapy.
Authors: Cheuk-Man Yu; Yat-Sun Chan; Qing Zhang; Gabriel W K Yip; Chi-Kin Chan; Leo C C Kum; LiWen Wu; Alex Pui-Wai Lee; Yat-Yin Lam; Jeffrey Wing-Hong Fung Journal: J Am Coll Cardiol Date: 2006-12-05 Impact factor: 24.094
Authors: Andrew E Epstein; John P DiMarco; Kenneth A Ellenbogen; N A Mark Estes; Roger A Freedman; Leonard S Gettes; A Marc Gillinov; Gabriel Gregoratos; Stephen C Hammill; David L Hayes; Mark A Hlatky; L Kristin Newby; Richard L Page; Mark H Schoenfeld; Michael J Silka; Lynne Warner Stevenson; Michael O Sweeney; Sidney C Smith; Alice K Jacobs; Cynthia D Adams; Jeffrey L Anderson; Christopher E Buller; Mark A Creager; Steven M Ettinger; David P Faxon; Jonathan L Halperin; Loren F Hiratzka; Sharon A Hunt; Harlan M Krumholz; Frederick G Kushner; Bruce W Lytle; Rick A Nishimura; Joseph P Ornato; Richard L Page; Barbara Riegel; Lynn G Tarkington; Clyde W Yancy Journal: J Am Coll Cardiol Date: 2008-05-27 Impact factor: 24.094
Authors: John F Beshai; Richard A Grimm; Sherif F Nagueh; James H Baker; Scott L Beau; Steven M Greenberg; Luis A Pires; Patrick J Tchou Journal: N Engl J Med Date: 2007-11-06 Impact factor: 91.245
Authors: Eugene S Chung; Angel R Leon; Luigi Tavazzi; Jing-Ping Sun; Petros Nihoyannopoulos; John Merlino; William T Abraham; Stefano Ghio; Christophe Leclercq; Jeroen J Bax; Cheuk-Man Yu; John Gorcsan; Martin St John Sutton; Johan De Sutter; Jaime Murillo Journal: Circulation Date: 2008-05-05 Impact factor: 29.690
Authors: Pekka Timonen; Jarkko Magga; Juha Risteli; Kari Punnonen; Esko Vanninen; Anu Turpeinen; Petri Tuomainen; Johanna Kuusisto; Olli Vuolteenaho; Keijo Peuhkurinen Journal: Int J Cardiol Date: 2007-04-17 Impact factor: 4.164
Authors: John Gorcsan; Theodore Abraham; Deborah A Agler; Jeroen J Bax; Genevieve Derumeaux; Richard A Grimm; Randy Martin; Jonathan S Steinberg; Martin St John Sutton; Cheuk-Man Yu Journal: J Am Soc Echocardiogr Date: 2008-03 Impact factor: 5.251
Authors: Ali Kemal Kalkan; Huseyin Altug Cakmak; Mehmet Emin Kalkan; Mehmet Altug Tuncer; Ebuzer Aydin; Mehmed Yanartas; Muhammet Hulusi Satilmisoglu; Hale Unal Aksu; Mehmet Erturk; Mehmet Gul; Ugur Arslantas; Mehmet Kaan Kirali Journal: Ann Noninvasive Electrocardiol Date: 2014-11-23 Impact factor: 1.468
Authors: Alexander Steger; Daniel Sinnecker; Anna Berkefeld; Alexander Müller; Josef Gebhardt; Michael Dommasch; Katharina M Huster; Petra Barthel; Georg Schmidt Journal: Herzschrittmacherther Elektrophysiol Date: 2015-09
Authors: Mehmet Eyuboglu; Mehmet Akif Ekinci; Suleyman Karakoyun; Ugur Kucuk; Omer Senarslan; Bahri Akdeniz Journal: Arq Bras Cardiol Date: 2016-10 Impact factor: 2.000