QRS micro-fragmentation as a mortality predictor.
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BORIS DOI
Date of Publication
October 21, 2022
Publication Type
Article
Division/Institute
Contributor
Hnatkova, Katerina | |
Andršová, Irena | |
Novotný, Tomáš | |
Britton, Annie | |
Shipley, Martin | |
Vandenberk, Bert | |
Sprenkeler, David J | |
Junttila, Juhani | |
Schlögl, Simon | |
Vos, Marc A | |
Friede, Tim | |
Bauer, Axel | |
Huikuri, Heikki V | |
Willems, Rik | |
Schmidt, Georg | |
Franz, Michael R | |
Sticherling, Christian | |
Zabel, Markus | |
Malik, Marek |
Subject(s)
Series
European heart journal
ISSN or ISBN (if monograph)
1522-9645
Publisher
Oxford University Press
Language
English
Publisher DOI
PubMed ID
35187560
Uncontrolled Keywords
Description
AIMS
Fragmented QRS complex with visible notching on standard 12-lead electrocardiogram (ECG) is understood to represent depolarization abnormalities and to signify risk of cardiac events. Depolarization abnormalities with similar prognostic implications likely exist beyond visual recognition but no technology is presently suitable for quantification of such invisible ECG abnormalities. We present such a technology.
METHODS AND RESULTS
A signal processing method projects all ECG leads of the QRS complex into optimized three perpendicular dimensions, reconstructs the ECG back from this three-dimensional projection, and quantifies the difference (QRS 'micro'-fragmentation, QRS-μf) between the original and reconstructed signals. QRS 'micro'-fragmentation was assessed in three different populations: cardiac patients with automatic implantable cardioverter-defibrillators, cardiac patients with severe abnormalities, and general public. The predictive value of QRS-μf for mortality was investigated both univariably and in multivariable comparisons with other risk factors including visible QRS 'macro'-fragmentation, QRS-Mf. The analysis was made in a total of 7779 subjects of whom 504 have not survived the first 5 years of follow-up. In all three populations, QRS-μf was strongly predictive of survival (P < 0.001 univariably, and P < 0.001 to P = 0.024 in multivariable regression analyses). A similar strong association with outcome was found when dichotomizing QRS-μf prospectively at 3.5%. When QRS-μf was used in multivariable analyses, QRS-Mf and QRS duration lost their predictive value.
CONCLUSION
In three populations with different clinical characteristics, QRS-μf was a powerful mortality risk factor independent of several previously established risk indices. Electrophysiologic abnormalities that contribute to increased QRS-μf values are likely responsible for the predictive power of visible QRS-Mf.
KEY QUESTION
KEY FINDING
TAKE-HOME MESSAGE
QRS-μf is a strong predictor of worsened survival. It can be assessed in standard short-term 12-lead electrocardiograms.
Fragmented QRS complex with visible notching on standard 12-lead electrocardiogram (ECG) is understood to represent depolarization abnormalities and to signify risk of cardiac events. Depolarization abnormalities with similar prognostic implications likely exist beyond visual recognition but no technology is presently suitable for quantification of such invisible ECG abnormalities. We present such a technology.
METHODS AND RESULTS
A signal processing method projects all ECG leads of the QRS complex into optimized three perpendicular dimensions, reconstructs the ECG back from this three-dimensional projection, and quantifies the difference (QRS 'micro'-fragmentation, QRS-μf) between the original and reconstructed signals. QRS 'micro'-fragmentation was assessed in three different populations: cardiac patients with automatic implantable cardioverter-defibrillators, cardiac patients with severe abnormalities, and general public. The predictive value of QRS-μf for mortality was investigated both univariably and in multivariable comparisons with other risk factors including visible QRS 'macro'-fragmentation, QRS-Mf. The analysis was made in a total of 7779 subjects of whom 504 have not survived the first 5 years of follow-up. In all three populations, QRS-μf was strongly predictive of survival (P < 0.001 univariably, and P < 0.001 to P = 0.024 in multivariable regression analyses). A similar strong association with outcome was found when dichotomizing QRS-μf prospectively at 3.5%. When QRS-μf was used in multivariable analyses, QRS-Mf and QRS duration lost their predictive value.
CONCLUSION
In three populations with different clinical characteristics, QRS-μf was a powerful mortality risk factor independent of several previously established risk indices. Electrophysiologic abnormalities that contribute to increased QRS-μf values are likely responsible for the predictive power of visible QRS-Mf.
KEY QUESTION
KEY FINDING
TAKE-HOME MESSAGE
QRS-μf is a strong predictor of worsened survival. It can be assessed in standard short-term 12-lead electrocardiograms.
File(s)
| File | File Type | Format | Size | License | Publisher/Copright statement | Content | |
|---|---|---|---|---|---|---|---|
| ehac085.pdf | text | Adobe PDF | 2.23 MB | Attribution (CC BY 4.0) | published |