Chanavuth Kanitsoraphan1, Pattara Rattanawong2,3, Poemlarp Mekraksakit4, Pakawat Chongsathidkiet5, Tanawan Riangwiwat2, Napatt Kanjanahattakij6, Wasawat Vutthikraivit7, Saranapoom Klomjit7, Subhanudh Thavaraputta7. 1. Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. 2. University of Hawaii Internal Medicine Residency Program, Honolulu, Hawaii. 3. Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. 4. Phramongkutklao College of Medicine, Bangkok, Thailand. 5. Department of Pathology, Duke University Medical Center, Durham, North Carolina. 6. Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania. 7. Department of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas.
Abstract
BACKGROUND: Recent studies suggested that fragmented (fQRS) is associated with poor clinical outcomes in heart failure with reduced ejection fraction (HFrEF) patients. However, no systematic review or meta-analysis has been done. We conducted a systematic review and meta-analysis to assess the association between baseline fQRS and all-cause mortality in HFrEF. METHODS: We comprehensively reviewed the databases of MEDLINE and EMBASE from inception to February 2018. Published studies of HFrEF that reported fQRS and outcome of all-cause mortality and major arrhythmic event (sudden cardiac death, sudden cardiac arrest, ventricular fibrillation, or sustained ventricular tachycardia) were included. Data were integrated using the random-effects, generic inverse-variance method of DerSimonian and Laird. RESULTS: Ten studies from 2010 to 2017 were included. Baseline fQRS was associated with increased all-cause mortality (risk ratio [RR] 1.63, 95% confidence interval [CI] 1.22-2.19, p < 0.0001, I2 = 73%) as well as major arrhythmic events (RR = 1.74, 95% CI 1.09-2.80, I2 = 89%). Baseline fQRS increased all-cause mortality in both Asian and Caucasian cohorts (RR = 2.17 with 95% CI 1.33-3.55 and RR = 1.45 with 95% CI 1.05-1.99, respectively) as well as increased major arrhythmic events in Asian cohort (RR = 1.50, 95% CI 1.05-2.13). Baseline fQRS also increased all-cause mortality in patients who had not received implantable cardioverter-defibrillator, significantly more than in patients who had received implantable cardioverter-defibrillator (RR = 2.46 with 95% CI 1.56-3.89 and 1.36 with 95% CI 1.08-1.71, respectively). CONCLUSION: Baseline fQRS is associated with increased all-cause mortality up to 1.63-fold in HFrEF patients. Fragmented QRS could be a predictor of clinical outcome in patients with HFrEF.
BACKGROUND: Recent studies suggested that fragmented (fQRS) is associated with poor clinical outcomes in heart failure with reduced ejection fraction (HFrEF) patients. However, no systematic review or meta-analysis has been done. We conducted a systematic review and meta-analysis to assess the association between baseline fQRS and all-cause mortality in HFrEF. METHODS: We comprehensively reviewed the databases of MEDLINE and EMBASE from inception to February 2018. Published studies of HFrEF that reported fQRS and outcome of all-cause mortality and major arrhythmic event (sudden cardiac death, sudden cardiac arrest, ventricular fibrillation, or sustained ventricular tachycardia) were included. Data were integrated using the random-effects, generic inverse-variance method of DerSimonian and Laird. RESULTS: Ten studies from 2010 to 2017 were included. Baseline fQRS was associated with increased all-cause mortality (risk ratio [RR] 1.63, 95% confidence interval [CI] 1.22-2.19, p < 0.0001, I2 = 73%) as well as major arrhythmic events (RR = 1.74, 95% CI 1.09-2.80, I2 = 89%). Baseline fQRS increased all-cause mortality in both Asian and Caucasian cohorts (RR = 2.17 with 95% CI 1.33-3.55 and RR = 1.45 with 95% CI 1.05-1.99, respectively) as well as increased major arrhythmic events in Asian cohort (RR = 1.50, 95% CI 1.05-2.13). Baseline fQRS also increased all-cause mortality in patients who had not received implantable cardioverter-defibrillator, significantly more than in patients who had received implantable cardioverter-defibrillator (RR = 2.46 with 95% CI 1.56-3.89 and 1.36 with 95% CI 1.08-1.71, respectively). CONCLUSION: Baseline fQRS is associated with increased all-cause mortality up to 1.63-fold in HFrEF patients. Fragmented QRS could be a predictor of clinical outcome in patients with HFrEF.
Authors: Daniel Levy; Satish Kenchaiah; Martin G Larson; Emelia J Benjamin; Michelle J Kupka; Kalon K L Ho; Joanne M Murabito; Ramachandran S Vasan Journal: N Engl J Med Date: 2002-10-31 Impact factor: 91.245
Authors: Andrew Brenyo; Grzegorz Pietrasik; Alon Barsheshet; David T Huang; Bronislava Polonsky; Scott McNitt; Arthur J Moss; Wojciech Zareba Journal: J Cardiovasc Electrophysiol Date: 2012-07-16
Authors: B Vandenberk; T Robyns; G Goovaerts; S Van Soest; V Floré; C Garweg; S Van Huffel; J Ector; R Willems Journal: Int J Cardiol Date: 2017-09-15 Impact factor: 4.164
Authors: Hasan Ali Barman; Eser Durmaz; Adem Atici; Serdar Kahyaoglu; Ramazan Asoglu; Irfan Sahin; Baris Ikitimur Journal: Ann Noninvasive Electrocardiol Date: 2019-06-02 Impact factor: 1.468