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Assessment of the association between the presence of fragmented QRS and the predicted risk score of sudden cardiac death at 5 years in patients with hypertrophic cardiomyopathy [Anatol J Cardiol]
Anatol J Cardiol. 2017; 18(1): 54-61 | DOI: 10.14744/AnatolJCardiol.2017.7593  

Assessment of the association between the presence of fragmented QRS and the predicted risk score of sudden cardiac death at 5 years in patients with hypertrophic cardiomyopathy

Sinem Özyılmaz1, Özgür Akgül2, Hüseyin Uyarel3, Hamdi Pusuroğlu2, Muammer Karayakalı2, Mehmet Gül2, Mustafa Çetin4, Hulusi Satılmışoğlu2, Aydın Yıldırım2, İhsan Bakır5
1Department of Cardiology, Faculty of Medicine, Biruni University; İstanbul-Turkey
2Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital; İstanbul-Turkey
3Department of Cardiology, Faculty of Medicine, Bezmialem Vakıf University; İstanbul-Turkey
4Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdoğan University; Rize-Turkey
5Department of Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital; İstanbul-Turkey

Objective: It has been shown that the presence of fragmented QRS (fQRS) is associated with poor prognosis in many cardiovascular diseases and in patients with hypertrophic cardiomyopathy (HCM). However, no study has shown an association with the absolute risk score of sudden cardiac death. The aim of this study was to determine the relationship between QRS and the predicted risk score of sudden cardiac death at 5 years (HCM Risk-SCD) in HCM patients.
Methods: In total, 115 consecutive HCM patients were included in this prospective observational study. The patients were divided into two groups according to the presence [fQRS(+) group (n=65)] or absence [fQRS(–) group (n=50)] of fQRS on a 12-lead electrocardiogram (ECG).
Results: The HCM Risk-SCD (%) HCM Risk-SCD (>6%) values and some echocardiographic parameters, including ventricular extrasystole, ventricular tachycardia, cardiopulmonary resuscitation, implantable cardioverter defibrillator implantation, appropriate shock, and heart failure at the time of admission, were significantly higher in the fQRS(+) group than in the fQRS(–) group (all p<0.05). Both univariate and multivariate analyses revealed fQRS and New York Heart Association (NYHA) class as independent predictors of HCM Risk-SCD. In a receiver operating characteristic (ROC) curve analysis, an HCM Risk-SCD value of >4 was identified as an effective cut-off point in fQRS for HCM. An HCM Risk-SCD value of >4 yielded a sensitivity of 77% and a specificity of 76%.
Conclusion: fQRS is determined to be an independent high-risk indicator of HCM Risk-SCD. It seems to be associated with increased ventricular arrhythmias and some echocardiographic parameters.

Keywords: fragmented QRS, hypertrophic cardiomyopathy, sudden cardiac death


Sinem Özyılmaz, Özgür Akgül, Hüseyin Uyarel, Hamdi Pusuroğlu, Muammer Karayakalı, Mehmet Gül, Mustafa Çetin, Hulusi Satılmışoğlu, Aydın Yıldırım, İhsan Bakır. Assessment of the association between the presence of fragmented QRS and the predicted risk score of sudden cardiac death at 5 years in patients with hypertrophic cardiomyopathy. Anatol J Cardiol. 2017; 18(1): 54-61

Corresponding Author: Sinem Özyılmaz, Türkiye


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