Could fragmented QRS predict mortality in aortic stenosis patients after transcatheter aortic valve replacement?

Fragmented QRS evaluated in 12-derivation electrocardiography has widely been accepted as a sign of myocardial fibrosis. The prognostic value of that marker has been demonstrated, particularly, in cardiac diseases that accompany myocardial scar and fibrosis. Myocardial fibrosis is also an issue in patients with aortic stenosis. In this study, we wanted to determine whether fragmented QRS could predict all-cause mortality in aortic stenosis patients after transcatheter aortic valve replacement (TAVR).

In this study, we evaluated a total of 116 eligible patients on whom we performed TAVR between 2014 and 2018. Patients' demographic and clinical findings, echocardiography results, in-hospital and 30-day mortality, long-term survival statuses were noted. Patient's ECGs before the procedure were evaluated in regard to the occurrence of fragmented QRS. Predictors of mortality were evaluated using univariable and multivariable Cox regression analysis.

The study population consisted of 116 patients of median age 79 (IQR 75-83), 64 females (55.2%). Mortality occurred in 27 (23%) patients; median follow-up time was 319 (IQR 122-719) days. Fragmented QRS was observed in 44 out of 116 (37.9%) patients. The presence of a fragmented QRS (HR = 2.178, 95% CI 0.999-4.847, p = 0.050), a history of stroke (HR = 3.463, 95% CI 1.276-9.398, p = 0.015), and the creatinine levels at admission (HR = 2.198, 95% CI 1.068-4.520, p = 0.030) were associated with the long-term mortality in multivariable Cox regression analysis.

Like in the case of the other diseases associated with myocardial fibrosis, fragmented QRS could also predict mortality in aortic stenosis patients after TAVR procedure.