James A Rosengarten1, Paul A Scott2, John M Morgan3. 1. Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth BH77DW, UK Faculty of Medicine, University of Southampton, Southampton, UK james@rosengarten.co.uk. 2. King's College Hospital NHS Foundation Trust, London, UK. 3. Faculty of Medicine, University of Southampton, Southampton, UK University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Abstract
AIMS: Risk stratification of sudden cardiac death (SCD) is challenging. Fragmented QRS (fQRS) is proposed as a non-invasive electrocardiogram marker associated with mortality and SCD. Results from individual studies including small numbers of patients are discrepant. We therefore performed a meta-analysis of studies evaluating fQRS as a risk stratification tool to predict all-cause mortality and SCD. METHODS AND RESULTS: Electronic databases and bibliographies were systematically searched (1996-2014). Twelve studies (5009 patients) recruiting patients with coronary artery disease or non-ischaemic cardiomyopathy met our inclusion criteria. Fragmented QRS was associated with an all-cause mortality relative risk of 1.71 (CI 1.02-2.85) and a relative risk of SCD of 2.20 (CI 1.05-4.62). Subgroup analysis demonstrated greater mortality and SCD risk in those with left ventricular ejection fraction >35% and SCD risk in those with QRS duration <120 ms. CONCLUSION: Fragmented QRS is associated with all-cause mortality and the occurrence of SCD and may be suited as a marker of SCD risk. The incremental benefit of fQRS should be assessed in a randomized, prospective setting. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Risk stratification of sudden cardiac death (SCD) is challenging. Fragmented QRS (fQRS) is proposed as a non-invasive electrocardiogram marker associated with mortality and SCD. Results from individual studies including small numbers of patients are discrepant. We therefore performed a meta-analysis of studies evaluating fQRS as a risk stratification tool to predict all-cause mortality and SCD. METHODS AND RESULTS: Electronic databases and bibliographies were systematically searched (1996-2014). Twelve studies (5009 patients) recruiting patients with coronary artery disease or non-ischaemic cardiomyopathy met our inclusion criteria. Fragmented QRS was associated with an all-cause mortality relative risk of 1.71 (CI 1.02-2.85) and a relative risk of SCD of 2.20 (CI 1.05-4.62). Subgroup analysis demonstrated greater mortality and SCD risk in those with left ventricular ejection fraction >35% and SCD risk in those with QRS duration <120 ms. CONCLUSION: Fragmented QRS is associated with all-cause mortality and the occurrence of SCD and may be suited as a marker of SCD risk. The incremental benefit of fQRS should be assessed in a randomized, prospective setting. Published on behalf of the European Society of Cardiology. All rights reserved.
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