QRS Fragmentation in Preserved Ejection Fraction Heart Failure: Functional Insights, Pathological Correlates, and...

Area of Science:

• Cardiology
• Electrophysiology
• Heart Failure Research

Background:

• Fragmented QRS (fQRS) is linked to myocardial scarring and increased risk in heart failure with reduced ejection fraction.
• The role of fQRS in heart failure with preserved ejection fraction (HFpEF) regarding pathophysiology and prognosis is not well-established.

Purpose of the Study:

• To investigate the pathophysiological correlates of fQRS in HFpEF patients.
• To determine the prognostic implications of fQRS in HFpEF.

Main Methods:

• A consecutive cohort of 960 HFpEF patients were analyzed.
• fQRS morphology was assessed using body surface ECG and categorized into non-fQRS, inferior fQRS, and anterior/lateral fQRS groups.
• Cardiac structure, function, diastolic indices, myocardial perfusion, and coronary flow were evaluated. Prognosis was assessed via Cox regression models for re-admission and mortality.

Main Results:

• Anterior/lateral fQRS was associated with higher B-type natriuretic peptide and troponin levels.
• Both inferior and anterior/lateral fQRS groups showed unfavorable cardiac remodeling, increased myocardial perfusion defects, and slower coronary flow.
• Anterior/lateral fQRS significantly increased HF re-admission risk (aHR 1.90) and both fQRS types were linked to higher cardiovascular and all-cause death risk.

Conclusions:

• fQRS in HFpEF correlates with more extensive myocardial perfusion defects and impaired cardiac mechanics, suggesting greater cardiac damage.
• Early identification of fQRS in HFpEF patients may identify individuals who would benefit from targeted therapeutic interventions.