The relation between coronary artery disease severity and fragmented QRS complex in patients with left bundle branch
Mohamed M Al-Daydamony1, Tamer M Mustafa1
1Cardiology Department, Faculty of Medicine, Zagazig University, Egypt.
Insights
Fragmented QRS (fQRS) on ECG may help identify obstructive coronary artery disease (CAD) in patients with left bundle branch block (LBBB). This simple ECG finding is a significant predictor of CAD, aiding noninvasive diagnosis.
Area of Science:
- Cardiology
- Electrocardiography
- Diagnostic Imaging
Background:
- Diagnosing coronary artery disease (CAD) in patients with left bundle branch block (LBBB) poses a significant clinical challenge.
- Fragmented QRS (fQRS) on surface ECG may indicate myocardial ischemia, scarring, or fibrosis, potentially correlating with CAD.
Purpose of the Study:
- To investigate the relationship between the presence of fQRS and the existence and severity of CAD in patients diagnosed with LBBB.
Main Methods:
- Fifty-six patients with suspected CAD and LBBB underwent ECG, echocardiography, and coronary angiography.
- Fragmented wide QRS (f-wQRS) complex was diagnosed via ECG.
- Obstructive CAD was defined by significant narrowing in major epicardial arteries or the left main coronary artery; Gensini score was calculated.
Main Results:
- Patients with f-wQRS showed a significantly higher prevalence of obstructive CAD (p=0.000053).
- The Gensini score was significantly elevated in patients with f-wQRS (p<0.00001).
- f-wQRS emerged as the sole independent predictor of obstructive CAD, with 80.1% sensitivity and 73.3% specificity.
Conclusions:
- Identifying f-wQRS in LBBB patients with suspected CAD is a straightforward, accessible method.
- This ECG finding may assist in the noninvasive prediction of obstructive CAD.
Background:
The diagnosis of coronary artery disease (CAD) in patients with LBBB represents a clinical challenge. The presence of fragmented QRS (fQRS) complex on surface ECG may be related to myocardial ischemia, scarring or fibrosis.
Objectives:
To investigate the relation between fQRS and the presence and severity of CAD in patients with LBBB.
Patients And Methods:
56 patients with symptoms suggesting CAD and complete LBBB were submitted to full history taking and clinical examination, complete 12-leads electrocardiography (ECG) to confirm the diagnosis of LBBB and to diagnose the fragmented wide QRS (f-wQRS) complex, echocardiography, and coronary angiography; lesions with ⩾70% narrowing in major epicardial artery or ⩾50% narrowing in the left main coronary artery were considered significant; and Gensini score was calculated. Patients were classified into two groups according to the presence or absence of f-wQRS.
Results:
There were significantly more patients with obstructive CAD among patients with f-wQRS (p = 0.000053). Gensini score was significantly higher in patients with than in patients without fwQRS (p < 0.00001). f-wQRS was the only significant independent predictor of obstructive CAD. Sensitivity of f-wQRS in predicting obstructive CAD was 80.1%, specificity was 73.3%, positive predictive value was 72.4%, negative predictive value was 81.5%, and overall accuracy was 76.8%, p = 0.0022.
Conclusion:
Seeking for f-wQRS in patients with LBBB and suspected CAD is a simple, easy, available, method that may be helpful in noninvasive prediction of obstructive CAD.
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