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Diagnostic value of fragmented QRS complex and early repolarization pattern in detecting myocardial fibrosis and inflammatory

Session Poster Session 2

Speaker Maria Gordeeva

Event : ESC Congress 2019

  • Topic : arrhythmias and device therapy
  • Sub-topic : Electrocardiography (ECG)
  • Session type : Poster Session

Authors : M Gordeeva (Saint Petersburg,RU), V Karlina (Saint Petersburg,RU), E Parmon (Saint Petersburg,RU), E Shlyakhto (Saint Petersburg,RU)

Authors:
M. Gordeeva1 , V. Karlina1 , E. Parmon1 , E. Shlyakhto1 , 1Federal Almazov Medical Research Centre - Saint Petersburg - Russian Federation ,

Topic(s):
Arrhythmias, General – Diagnostic Methods: Electrocardiography

Citation:
European Heart Journal ( 2019 ) 40 ( Supplement ), 1160

Myocardial fibrosis (MF) and inflammatory (MI) play a significant role in pathogenesis of arrhythmias, heart failure and sudden cardiac death. Endomyocardial biopsy (EMB) and cardiac magnetic resonance with late gadolinium enhancement (CMRI-LGE) are used to detect this structural abnormalities. These methods are very informative but not a screening. ECG patterns: fragmented QRS complex (fQRS) and early repolarization (ERP) can be used as markers of MF and MI.

Purpose: To analyze the relationship between structural changes of myocardium, determined using by CMRI-LGE and EMB and fQRS and ERP.

Materials and methods: We analyzed results of CMRI-LG, EMB and 12-lead ECG in 46 patients (28 male, median age – 47.3±12.7). We used the criteria by Das M., 2006 to identify FQRS and the criteria by Macfarlane P.W., 2015 to identify ERP.

Results: Based on the results of CMRI-LGE and EMB all patients were divided into 3 groups: 1st – 20 patients (70% male, median age 56 (48.5; 58.5)) with acute inflammatory (more then 14 leucocytes per mm2) and myocardial fibrosis (detecting by EMB and/or CMRI-LGE); 2nd group – 20 patients (65% male, median age 37 (28.0; 49.5)) with myocardial fibrosis without inflammatory changes; 3rd group – 6 patients without fibrosis or inflammatory. In the 1st group fQRS were detected in 7 (35%) patients, ERP – 6 (30%). In the 2nd group fQRS were detected in 5 (25%) patients, ERP – 6 (0%). In the 3rd group fQRS were not detected in 7 (35%) patients, ERP – 6 (30%).

We assessed sensitivity and specificity of fQRS and ERP in detected MF and MI by comparing with CMRI-LGE and EMB (table 1).

Conclusions: FQRS have significant sensitivity (83.3%) and specificity (56%) for detecting MF. And ERP has significant sensitivity (85.7%) and specificity (66.7%) for detecting MI. This ECG patterns could be discussed as screening markers of structural myocardial abnormalities.

Sensitivity and specificity ECG patterns
Myocardial fibrosisMyocardial inflammatory
ECG patternMethodSensitivitySpecificityECG patternMethodSensitivitySpecificity
FQRSEMB76.9%39.4%FQRSEMB53.8%63.6%
MRI83.3%56.0%MRI30.8%84.0%
ERPEMB42.9%30.8%ERPEMB85.7%66.7%
MRI50.0%41.9%MRI33.3%81.3%
FQRS, fragmented QRS; ERP, early repolarization pattern; EMB, endomyocardial biopsy; MRI, cardiac magnetic resonance with late gadolinium enhancement.

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