Exploring the Impact of Fragmented QRS on Ejection Fraction and Other Echocardiographic Parameters in Systemic Sclerosis Patients: A Retrospective Cohort Study
-
Aida Mohamadi
,
Zahra Tamartash
,
Sepehr Nayebirad
,
Farhad Gharibdoost
,
Zahra Javady Nejad
,
Maedeh Majidi Shad
,
Motahare Hatami
,
Hoda Kavosi
Abstract
Background: Systemic sclerosis (SSc) is an autoimmune connective tissue disorder that leads to fibrosis of the skin and internal organs. Fragmented QRS (fQRS) is an important electrocardiographic (ECG) finding related to myocardial fibrosis. This study aimed to evaluate the effect of fQRS on ejection fraction (EF) and other echocardiographic parameters in individuals diagnosed with SSc.
Methods: This was a retrospective cohort study consisting of 52 patients with fQRS as the case group and 60 patients without fQRS as the control group. The characteristics and echocardiographic parameters of the patients from a minimum of a 3-year interval were recorded. All data were compared between the two groups using SPSS software, version 20.0 (IBM Corp).
Results: There were no significant differences in demographics, paraclinical results, and echocardiographic parameters, including average EF, pulmonary hypertension, and tricuspid regurgitation velocity, between cases and controls at the beginning and end of the follow-up.
Conclusion: Based on our results, fQRS had no significant effect on EF and other echocardiographic parameters over at least a 3-year interval in SSc patients. However, additional research with longer follow-up periods and larger sample sizes is needed to characterize the association fully.
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13. Hinderer S, Schenke-Layland K. Cardiac fibrosis – A short review of causes and therapeutic strategies. Adv Drug Deliv Rev. 2019;146:77-82.
14. von Elm E AD, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008 Apr;61(4):344-9.
15. Van Den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A, et al. 2013 classification criteria for systemic sclerosis: an American College of Rheumatology/European League against Rheumatism collaborative initiative. Arthritis Rheum. 2013;65(11):2737-47.
16. Chemla D, Humbert M, Sitbon O, Montani D, Hervé P. Systolic and Mean Pulmonary Artery Pressures: Are They Interchangeable in Patients with Pulmonary Hypertension? Chest. 2015;147(4):943-50.
17. Sumimoto K, Tanaka H, Mukai J, Yamashita K, Tanaka Y, Shono A, et al. Optimal Cut-Off of Tricuspid Regurgitation Velocity According to the New Definition of Pulmonary Hypertension - Its Use in Predicting Pulmonary Hypertension. Circ Rep. 2020;2(10):625-9.
18. Kosaraju A, Goyal A, Grigorova Y, Makaryus AN. Left ventricular ejection fraction. 2017.
19. Nikoo MH, Jamali Z, Razeghian-Jahromi I, Sayadi M, Verdecchia P, Abtahi F. Fragmented QRS as an early predictor of left ventricular systolic dysfunction in healthy individuals: a nested case-control study in the era of speckle tracking echocardiography. Cardiovasc Ultrasound. 2020;18(1):33.
20. Dehghani MR, Rostamzadeh A, Abbasnezhad A, Shariati A, Nejatisafa S, Rezaei Y. Fragmented QRS and subclinical left ventricular dysfunction in individuals with preserved ejection fraction: A speckle-tracking echocardiographic study. J Arrhythm. 2020;36(2):335-40.
21. Bayar N, Çay HF, Erkal Z, Sezer İ, Arslan Ş, Çağırcı G, et al. The importance of fragmented QRS in the early detection of cardiac involvement in patients with systemic sclerosis. Anatol J Cardiol. 2015;15(3):209-12.
22. Hidayet Ş, Yağmur J, Bayramoğlu A, Cansel M, Ermiş N, Taşolar H, et al. Fragmented QRS complexes are associated with subclinical left ventricular dysfunction in patients with Behcet's disease: Four-dimensional speckle tracking echocardiography. J Clin Ultrasound. 2021;49(3):227-33.
23. Karaca Y, Karasu M, Taşolar H, Evren B. Four-dimensional speckle tracking echocardiography and fragmented QRS in detection of early left ventricular systolic dysfunction in patients with subclinical hyperthyroidism. J Clin Ultrasound. 2023;51(6):939-48.
24. Yılmaz E, Aydın E, Çamcı S, Aydın E. Frequency of fragmented QRS on ECG and relationship with left ventricular dysfunction in patients with subclinical hypothyroidism. Eur Rev Med Pharmacol Sci. 2022;26(10):3677-85.
25. Bayramoğlu A, Taşolar H, Kaya Y, Bektaş O, Kaya A, Yaman M, et al. Fragmented QRS complexes are associated with left ventricular dysfunction in patients with type-2 diabetes mellitus: a two-dimensional speckle tracking echocardiography study. Acta Cardiol. 2018;73(5):449-56.
2. Steen VD, Medsger TA Jr. Severe organ involvement in systemic sclerosis with diffuse scleroderma. Arthritis Rheum. 2000 Nov;43(11):2437-44.
3. Ferri C, Valentini G, Cozzi F, Sebastiani M, Michelassi C, La Montagna G, et al. Systemic sclerosis: demographic, clinical, and serologic features and survival in 1,012 Italian patients. Medicine (Baltimore). 2002;81(2):139-53.
4. Al-Dhaher FF, Pope JE, Ouimet JM. Determinants of morbidity and mortality of systemic sclerosis in Canada. Semin Arthritis Rheum. 2010 Feb;39(4):269-77.
5. Champion HC. The heart in scleroderma. Rheum Dis Clin North Am. 2008;34(1):181-90.
6. Bruni C, Ross L. Cardiac involvement in systemic sclerosis: Getting to the heart of the matter. Best Practice & Research Clinical Rheumatology. 2021;35(3):101668.
7. Butt SA, Jeppesen JL, Torp‐Pedersen C, Sam F, Gislason GH, Jacobsen S, et al. Cardiovascular manifestations of systemic sclerosis: a Danish nationwide cohort study. J Am Heart Assoc. 2019;8(17):e013405.
8. Take Y, Morita H. Fragmented QRS: What is the meaning? Indian Pacing Electrophysiol J. 2012;12(5):213-25.
9. Das MK, Saha C, El Masry H, Peng J, Dandamudi G, Mahenthiran J, et al. Fragmented QRS on a 12-lead ECG: a predictor of mortality and cardiac events in patients with coronary artery disease. Heart rhythm. 2007;4(11):1385-92.
10. Pietrasik G, Goldenberg I, Zdzienicka J, Moss AJ, Zareba W. Prognostic significance of fragmented QRS complex for predicting the risk of recurrent cardiac events in patients with Q-wave myocardial infarction. Am J Cardiol. 2007;100(4):583-6.
11. Javinani A, Nejad ZJ, Gharibdoost F, Jamshidi AR, Yekta RA, Alvand S, et al. Bundle branch blocks and fragmented QRS complex in Iranian patients with systemic sclerosis. J Tehran Heart Cent. 2019;14(1):6-11.
12. Tigen K, Sunbul M, Ozen G, Durmus E, Kivrak T, Cincin A, et al. Regional myocardial dysfunction assessed by two-dimensional speckle tracking echocardiography in systemic sclerosis patients with fragmented QRS complexes. J Electrocardiol. 2014;47(5):677-83.
13. Hinderer S, Schenke-Layland K. Cardiac fibrosis – A short review of causes and therapeutic strategies. Adv Drug Deliv Rev. 2019;146:77-82.
14. von Elm E AD, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008 Apr;61(4):344-9.
15. Van Den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A, et al. 2013 classification criteria for systemic sclerosis: an American College of Rheumatology/European League against Rheumatism collaborative initiative. Arthritis Rheum. 2013;65(11):2737-47.
16. Chemla D, Humbert M, Sitbon O, Montani D, Hervé P. Systolic and Mean Pulmonary Artery Pressures: Are They Interchangeable in Patients with Pulmonary Hypertension? Chest. 2015;147(4):943-50.
17. Sumimoto K, Tanaka H, Mukai J, Yamashita K, Tanaka Y, Shono A, et al. Optimal Cut-Off of Tricuspid Regurgitation Velocity According to the New Definition of Pulmonary Hypertension - Its Use in Predicting Pulmonary Hypertension. Circ Rep. 2020;2(10):625-9.
18. Kosaraju A, Goyal A, Grigorova Y, Makaryus AN. Left ventricular ejection fraction. 2017.
19. Nikoo MH, Jamali Z, Razeghian-Jahromi I, Sayadi M, Verdecchia P, Abtahi F. Fragmented QRS as an early predictor of left ventricular systolic dysfunction in healthy individuals: a nested case-control study in the era of speckle tracking echocardiography. Cardiovasc Ultrasound. 2020;18(1):33.
20. Dehghani MR, Rostamzadeh A, Abbasnezhad A, Shariati A, Nejatisafa S, Rezaei Y. Fragmented QRS and subclinical left ventricular dysfunction in individuals with preserved ejection fraction: A speckle-tracking echocardiographic study. J Arrhythm. 2020;36(2):335-40.
21. Bayar N, Çay HF, Erkal Z, Sezer İ, Arslan Ş, Çağırcı G, et al. The importance of fragmented QRS in the early detection of cardiac involvement in patients with systemic sclerosis. Anatol J Cardiol. 2015;15(3):209-12.
22. Hidayet Ş, Yağmur J, Bayramoğlu A, Cansel M, Ermiş N, Taşolar H, et al. Fragmented QRS complexes are associated with subclinical left ventricular dysfunction in patients with Behcet's disease: Four-dimensional speckle tracking echocardiography. J Clin Ultrasound. 2021;49(3):227-33.
23. Karaca Y, Karasu M, Taşolar H, Evren B. Four-dimensional speckle tracking echocardiography and fragmented QRS in detection of early left ventricular systolic dysfunction in patients with subclinical hyperthyroidism. J Clin Ultrasound. 2023;51(6):939-48.
24. Yılmaz E, Aydın E, Çamcı S, Aydın E. Frequency of fragmented QRS on ECG and relationship with left ventricular dysfunction in patients with subclinical hypothyroidism. Eur Rev Med Pharmacol Sci. 2022;26(10):3677-85.
25. Bayramoğlu A, Taşolar H, Kaya Y, Bektaş O, Kaya A, Yaman M, et al. Fragmented QRS complexes are associated with left ventricular dysfunction in patients with type-2 diabetes mellitus: a two-dimensional speckle tracking echocardiography study. Acta Cardiol. 2018;73(5):449-56.
| Files | ||
| Issue | Vol 20 No 4 (2025) | |
| Section | Original Article(s) | |
| Keywords | ||
| Fragmented QRS FQRS Scleroderma Ejection Fraction Systemic Sclerosis Pulmonary Hypertension | ||
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How to Cite
1.
Mohamadi A, Tamartash Z, Nayebirad S, Gharibdoost F, Javady Nejad Z, Majidi Shad M, Hatami M, Kavosi H. Exploring the Impact of Fragmented QRS on Ejection Fraction and Other Echocardiographic Parameters in Systemic Sclerosis Patients: A Retrospective Cohort Study. Res Heart Yield Transl Med. 2025;20(4):259-265.
