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[The relationship between fragmented QRS complex and coronary collateral circulation in patients with chronic total
1Department of Cardiology, Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing 210006, China.
Insights
Fragmented QRS complex (fQRS) is linked to poor coronary collateral circulation (CCC) in patients with chronic total occlusion (CTO) lesions. This electrocardiogram finding may indicate reduced blood flow in CTO patients without prior heart attacks.
Area of Science:
- Cardiology
- Electrocardiography
- Vascular Biology
Background:
- Coronary collateral circulation (CCC) is crucial for myocardial perfusion in chronic total occlusion (CTO) patients.
- Fragmented QRS complex (fQRS) on electrocardiogram (ECG) may reflect myocardial scar or ischemia.
- The relationship between fQRS and CCC in CTO patients without prior myocardial infarction (MI) remains underexplored.
Purpose of the Study:
- To investigate the association between fQRS and the quality of CCC in patients presenting with CTO lesions.
- To determine if fQRS is an independent predictor of poor CCC in this specific patient cohort.
Main Methods:
- Retrospective analysis of 238 consecutive patients with CTO lesions.
- Classification of CCC into poor (Rentrop grade 0-1) and good (Rentrop grade 2-3) groups.
- ECG analysis to identify fQRS, defined by specific waveform abnormalities in relevant leads.
- Multivariate logistic regression to assess the independent relationship between fQRS and CCC.
Main Results:
- Patients with poor CCC were older, had higher plasma glucose, and lower left ventricular ejection fraction.
- The prevalence of fQRS was significantly higher in the poor CCC group (69.0%) compared to the good CCC group (31.1%).
- fQRS was found to be an independent predictor of poor CCC in patients with CTO lesions (OR=3.659, P<0.01).
Conclusions:
- Poor CCC in patients with CTO lesions and no prior MI is independently associated with the presence of fQRS on ECG.
- fQRS may serve as a non-invasive marker to identify patients with inadequate collateral blood supply in CTO.
- Further research is warranted to elucidate the underlying mechanisms and clinical implications of this association.
Abstract:
Objective: To explore the relationship between fragmented QRS complex(fQRS) and coronary collateral circulation(CCC) in patients with chronic total occlusion(CTO)lesion without prior myocardial infarction. Methods: This retrospective study analyzed 238 consecutive patients with CTO lesion in one of the major coronary arteries from May 2014 to October 2015 in our department. Patients were divided into poor CCC group (grade 0 and 1, 58 cases) and good CCC group(grade 2 and 3, 180 cases) based on Rentrop's classification of CCC. The fQRS was defined as the presence of an additional R wave or notching of R or S wave or the presence of fragmentation in two contiguous electrocardiogram leads corresponding to a major coronary artery territory. Multivariate logistic regression was used to analyze the relationship between CCC and fQRS on electrocardiogram. Results: Compared with good CCC group, patients in poor CCC group had older age((65.2±8.9)years old vs. (60.3±10.1) years old, P=0.03), higher plasma glucose ((7.22±3.00) mmol/L vs.(6.31±1.83)mmol/L, P=0.04), and lower left ventricular ejection fraction ((45.2±11.4)% vs. (51.2±13.5)%, P=0.02). None of patients had Rentrop grade 0, the presence of fQRS on ECG in patients with Rentrop grade 1, grade 2, and grade 3 CCC was 69.0% (40/58), 48.6% (35/72) , and 19.4% (21/108), respectively (P<0.01). The presence of fQRS were higher in poor CCC group than in good CCC group (69.0%(40/58)vs. 31.1%(56/180), P<0.01), and number of leads with fQRS were higher in poor CCC group than in good CCC group (3(0, 4)vs.0(0, 3), P<0.01). Multivariate logistic regression analysis demonstrated that poor CCC growth in patients with CTO lesion without prior myocardial infarction was independently related to the presence of fQRS (OR=3.659, 95%CI 1.619-8.217, P<0.01). Conclusion: Poor CCC in patients with CTO lesion without prior myocardial infarction is independently related to the presence of fQRS on electrocardiogram.
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