In line with the ESC mission, newly presented content is made available to all for a limited time (4 months for ESC Congress, 3 months for other events). ESC Professional Members, Association Members (Ivory & above) benefit from year-round access to all the resources from their respective Association, and to all content from previous years. Fellows of the ESC (FESC), and Professionals in training or under 40 years old, who subscribed to a Young Combined Membership package benefit from access to all ESC 365 content from all events, all editions, all year long. Find out more about ESC Memberships here.
Fragmented QRS relates to myocardial fibrosis and syncopal episodes in hypertrophic cardiomyopathy
Sub-topic : Prevention – Cardiovascular Risk Assessment, Other
Session type : Poster Session
Authors : Z Dohy (Budapest,HU), C Czimbalmos (Budapest,HU), I Csecs (Budapest,HU), FI Suhai (Budapest,HU), A Toth (Budapest,HU), V Juhasz (Budapest,HU), L Szabo (Budapest,HU), Z Pozsonyi (Budapest,HU), A Vereckei (Budapest,HU), B Merkely (Budapest,HU), H Vago (Budapest,HU)
1Semmelweis University Heart Center - Budapest - Hungary
2Semmelweis University - Budapest - Hungary
Introduction: Structural changes of myocardium, such as myocardial fibrosis, in hypertrophic cardiomyopathy (HCM) are associated with electrophysiological abnormalities, eg. pathological Q-wave or fragmented QRS (fQRS). Cardiac magnetic resonance (CMR) is the only non-invasive method used to detect and quantify the myocardial fibrosis.
Purpose: Aim of our study was to investigate the correlation between fQRS, Q wave and CMR characteristics in HCM, and their prognostic role.
Methods: In this study we investigated 85 consecutive patients (47 male; 48.4±16.2 years) with HCM, who underwent CMR with late gadolinium enhancement and standard 12-lead ECG. Using cine short-axis images we evaluated left ventricular ejection fraction, volumes, mass and maximal end-diastolic wall thickness (MaxEDWT). On delayed contrast enhancement images the myocardial fibrosis was quantified. Standard 12-lead ECG records of patients with HCM were analysed, we examined the presence of pathological Q-wave and fQRS. During clinical follow-up adverse cardiac events and cardiac complaints were recorded.
Results: Pathological Q-wave was detected in 23 (27%) patients, fQRS was present in 35 (41%) patients. fQRS was present most frequently in inferior leads (21 cases), followed by lateral (15 cases) and anterior leads (13 cases). Patients with fQRS had more myocardial fibrosis (26.1±30.5 vs. 14.6±20.3 g, p<0.05) and higher MaxEDWT (22.8±5.7 vs. 19.9±5.6 mm, p<0.05). There was no difference in the amount of fibrosis and MaxEDWT between patients with and without pathological Q-wave.
During clinical follow-up (881±619 days) one patient died, two patients had adequate ICD therapy, 17 further patients were hospitalized because of arrhythmia, heart failure, syncope or chest pain. Patients with fQRS had more often syncope compared to patients without fQRS (53.3% vs. 9.5%, p<0.01).
Conclusion: Although pathological Q-wave is traditionally considered a myocardial scar marker, we found no difference in the amount of fibrosis between patients with and without pathological Q-wave. In contrast, patients with fQRS had significantly higher amount of fibrosis. fQRS was also associated with higher maximal end-diastolic wall thickness and more frequent syncope.
Figure 1. Delayed contrast enhancement images (A-B) and ECG record with fQRS (C) of patient with HCM.
ESC 365 is supported by Bayer, Boehringer Ingelheim and Lilly Alliance, Bristol-Myers Squibb and Pfizer Alliance, Novartis Pharma AG and Vifor Pharma in the form of educational grants. The sponsors were not involved in the development of this platform and had no influence on its content.
Our mission: To reduce the burden of cardiovascular disease