Fragmented QRS and myocardial performance index in nephrotic syndrome.

To the Editor,

The recent report on “Fragmented QRS and myocardial performance index in nephrotic syndrome” published is very interesting (1). Özkan et al. (1) concluded that the “determination of fQRS in patients with nephrotic syndrome (NS) in surface ECG, an easily accessible technique, can be used as a parameter in the prediction of myocardial functions.” In fact, it is already known that “fQRS may be useful in identifying patients at higher cardiac risk with larger areas of ischemic jeopardized or necrotic myocardium (2).” Hence, the similar finding among patients with NS is not a surprising finding. Nevertheless, an important factor to be concerned in the patient with NS is the medication. In the case of long-term use of steroid, the effect on the QRS can be expected (3), and this might decrease the utility of fragmented QRS detection. In the present report (1), the use of steroid is not mentioned well, and its effect on the diagnostic property of fragmented QRS is an interesting issue to be discussed.