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.