Fragmented QRS and ejection fraction in heart failure patients admitted to the hospital

Abstract

Background: Fragmented QRS (FQRS) in 12 lead ECG was recently correlated with various outcomes in ischemic and non-ischemic heart disease. We studied the relationship between FQRS and ejection fraction (EF) in heart failure patients with QRS < 120 ms. Methods: Medical records and echocardiograms of 339 patients admitted with CHF were reviewed. ECGs were read twice by a reader blinded to all data. Results: 70 patients with wide QRS were excluded; 63 patients had FQRS and 206 patients did not have FQRS. FQRS group were more likely to be black (OR = 2.17; p = 0.0093), and diabetic (OR = 1.79; p = 0.0451). ROC curve analysis revealed a significant relationship between EF and FQRS (p = 0.002). At EF of 48%, OR for FQRS was 4.36 (95% CI: 2.1–9.05; p < .0001). Adjustment for race and diabetes did not change the OR, or confidence intervals (Adjusted OR for race: 4.08 (95% CI: 1.06–15.67; p = 0.04); for diabetes: 4.13 (95% CI: 1.46–11.69; p = 0.008)). There was a significant difference in EF between patients with FQRS involving ≥2 ECG areas and non-FQRS group (p < 0.05), but not between patients with ≥2 vs. one area, or 1 area vs. non-FQRS. Conclusion: In heart failure patients with QRS < 120 ms, FQRS was observed more frequently in persons of black race and in diabetics and was associated with lower EF. This was mainly seen in patients with FQRS involving ≥2 ECG areas.

Keywords

• Congestive heart failure
• Fragmented QRS
• Ejection fraction
• ECG