Fragmented QRS Predicts Heart Failure Progression in Patients With Hypertrophic Cardiomyopathy

Access this Article

Author(s)

    • Nomura Akihiro
    • Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine
    • Kawashiri Masa-aki
    • Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine
    • Fujino Noboru
    • Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine
    • Yamagishi Masakazu
    • Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine|Research and Education Center for Innovative and Preventive Medicine, Kanazawa University
    • Hayashi Kenshi
    • Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine
    • Konno Tetsuo
    • Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine|Research and Education Center for Innovative and Preventive Medicine, Kanazawa University
    • Fujita Takashi
    • Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine
    • Tanaka Yoshihiro
    • Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine
    • Nagata Yoji
    • Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine
    • Tsuda Toyonobu
    • Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine
    • Hodatsu Akihiko
    • Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine
    • Sakata Kenji
    • Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine
    • Nakamura Hiroyuki
    • Research and Education Center for Innovative and Preventive Medicine, Kanazawa University|Department of Public Health, Graduate School of Medical Science, Kanazawa University

Abstract

<b><i>Background:</i></b>Although fragmented QRS complex (frag-QRS) reflecting intra-ventricular conduction delay has been shown to be a prognostic marker for cardiac events, few data exist regarding the impact of frag-QRS on cardiac events in hypertrophic cardiomyopathy (HCM).<b><i>Methods and Results:</i></b>Ninety-four HCM patients (56 male; mean age, 58±17 years) were retrospectively investigated. Frag-QRS was defined as the presence of various RsR' patterns in at least 2 contiguous ECG leads. Major arrhythmic events (MAE) were defined as sudden cardiac death, and combined sustained ventricular tachycardia/ventricular fibrillation. New-onset atrial fibrillation (AF) was diagnosed based on ECG during provisional or routine medical examination. Heart failure (HF) with hospitalization was defined as hospital admission due to subjective or objective symptoms. Frag-QRS was detected in 31 patients (33%).<i>TNNI3</i>was the most frequent disease-causing gene. Median follow-up was 4.6 years. The 4-year cumulative survival rates of cardiac death, MAE, new-onset AF and HF with hospitalization were 97.6%, 94.6%, 87.5% and 89.3%, respectively. On multivariate analysis, frag-QRS was significantly associated with HF with hospitalization (adjusted hazard ratios [95% confidence intervals]: 5.4 [1.2–36], P=0.03). Moreover, HF-free survival was significantly lower in the frag-QRS (+) group compared to the frag-QRS (–) group (79.0% vs. 95.1%, P=0.03).<b><i>Conclusions:</i></b>Frag-QRS is associated with HF with hospitalization in HCM patients who had a unique distribution of gene mutations. (<i>Circ J</i> 2015; <b>79:</b> 136–143)

Journal

  • Circulation Journal

    Circulation Journal 79(1), 136-143, 2014

    The Japanese Circulation Society

Codes

Page Top