In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.


The free consultation period for this content is over.

It is now only available year-round to ESC Professional Members, Fellows of the ESC, and Young combined Members

Fragmented QRS relates to myocardial fibrosis and syncopal episodes in hypertrophic cardiomyopathy

Session Poster Session 5

Speaker Zsofia Dohy

Congress : ESC Congress 2018

  • Topic : preventive cardiology
  • Sub-topic : Prevention - Cardiovascular Risk Assessment, Other
  • Session type : Poster Session
  • FP Number : P4457

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)

Authors:
Z. Dohy1 , C. Czimbalmos1 , I. Csecs1 , F.I. Suhai1 , A. Toth1 , V. Juhasz1 , L. Szabo1 , Z. Pozsonyi2 , A. Vereckei2 , B. Merkely1 , H. Vago1 , 1Semmelweis University Heart Center - Budapest - Hungary , 2Semmelweis University - Budapest - Hungary ,

Citation:
European Heart Journal ( 2018 ) 39 ( Supplement ), 898

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.


Based on your interests

Members get more

Join now
  • 1ESC Professional Members – access all resources from ESC Congress and ESC Asia with APSC & AFC
  • 2ESC Association Members (Ivory, Silver, Gold) – access your Association’s congress resources
  • 3Under 40 or in training - with a Combined Membership, access resources from all congresses
Join now

Our sponsors

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.

logo esc

Our mission: To reduce the burden of cardiovascular disease

Who we are