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QRS fragmentation is superior to QRS duration in predicting mortality in adults with tetralogy of Fallot.
- Source :
- Heart; 11/1/2016, Vol. 102 Issue 21, pN.PAG-N.PAG, 1p
- Publication Year :
- 2016
-
Abstract
- <bold>Background: </bold>Although QRS duration >180 ms has prognostic value in adults with tetralogy of Fallot (TOF), its sensitivity to predict mortality is low. Fragmented QRS complexes, a simple measurement on ECG, are related to myocardial fibrosis and dysfunction in patients with TOF. Our objective was to determine whether QRS fragmentation predicts major outcomes in TOF.<bold>Methods: </bold>This multicentre study included adult patients with TOF from a prospective registry. Notches in the QRS complex in ≥2 contiguous leads on a 12-lead ECG, not related to bundle branch block, were defined as QRS fragmentation, which was classified as none, moderate (≤4 leads) or severe (≥5 leads). The primary and secondary outcomes were all-cause mortality and clinical ventricular arrhythmia, respectively.<bold>Results: </bold>A total of 794 adult patients with TOF (median age 27 years, 55% male; 52% no QRS fragmentation, 32% moderate, 16% severe) were included. During long-term (median 10.4 years) follow-up, 46 (6%) patients died and 35 (4%) patients had ventricular arrhythmias. Overall, 10-year survival was 98% in patients without fragmented QRS complexes, 93% in patients with moderate QRS fragmentation and 81% in patients with severe QRS fragmentation. In multivariable Cox hazards regression analysis, extent of QRS fragmentation (HR: 2.24/class, 95% CI 1.48 to 3.40, p<0.001) remained independently predictive for mortality, whereas QRS duration was not predictive (p=0.85). The extent of QRS fragmentation was also independently predictive for ventricular arrhythmia (HR: 2.00/class, 95% CI 1.26 to 3.16, p=0.003).<bold>Conclusions: </bold>The extent of QRS fragmentation is superior to QRS duration in predicting mortality in adult patients with TOF and may be used in risk stratification. [ABSTRACT FROM AUTHOR]
- Subjects :
- ARRHYTHMIA diagnosis
ACTION potentials
ARRHYTHMIA
CHI-squared test
COMPARATIVE studies
CAUSES of death
ELECTROCARDIOGRAPHY
HEART beat
HEART conduction system
RESEARCH methodology
MEDICAL cooperation
MULTIVARIATE analysis
PROGNOSIS
RESEARCH
RISK assessment
TETRALOGY of Fallot
TIME
EVALUATION research
PREDICTIVE tests
ACQUISITION of data
PROPORTIONAL hazards models
RETROSPECTIVE studies
KAPLAN-Meier estimator
DISEASE complications
DIAGNOSIS
Subjects
Details
- Language :
- English
- ISSN :
- 13556037
- Volume :
- 102
- Issue :
- 21
- Database :
- Complementary Index
- Journal :
- Heart
- Publication Type :
- Academic Journal
- Accession number :
- 119580846
- Full Text :
- https://doi.org/10.1136/heartjnl-2016-310068