Fragmented QRS complexes are not hallmarks of myocardial injury as detected by cardiac magnetic resonance imaging in patients with acute myocardial infarction

Min Soo Ahn, Jin Bae Kim, Byung Su Yoo, Jun Won Lee, Ji Hyun Lee, Young Jin Youn, Sung Gyun Ahn, Jang Young Kim, Seung Hwan Lee, Junghan Yoon, Kyung Hoon Choe

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Abstract

Background Q waves on a 12-lead electrocardiography (ECG) are considered to be classic hallmarks of prior myocardial infarction. However, one study suggested that the fragmented QRS complex (fQRS) on ECG is a highly sensitive and specific marker of myocardial scarring on a nuclear stress test. The study aimed to investigate the diagnostic accuracy of fragmented QRS complexes compared with Q waves for myocardial injury detected by delayed contrast-enhanced cardiovascular magnetic resonance imaging (DE-CMRI) in subjects with acute myocardial infarction. Methods Electrocardiograms of 190 subjects with myocardial infarction who underwent DE-CMR were analyzed. fQRS was defined by the presence of an additional R wave (R″), or notching of the S wave, or more than one R′ in two contiguous leads. Results Delayed enhancement was observed in 180 (94.7%) patients. Transmural enhancement was noted in 78 (43.3%) and subendocardial enhancement in 102 (56.7%) patients. The sensitivity and specificity of Q waved and fQRS for diagnosing delayed enhancement were 59.4% vs. 66.7% and 90.0% vs. 40.0%. The area under the receiver-operator characteristics curve of delayed enhancement was 0.75 for Q waves and 0.53 for fQRS (p = 0.04). The areas under the ROC curves of the transmurality of delayed enhancement were 0.44 for fQRS and 0.58 for Q waves (p = 0.73). Conclusions fQRS has poor accuracy for the detection of myocardial injury compared with Q waves. fQRS and Q waves are not valuable tools for the diagnosis transmural irreversible myocardial injury in acute myocardial infarction.

Original languageEnglish
Pages (from-to)2008-2013
Number of pages6
JournalInternational Journal of Cardiology
Volume168
Issue number3
DOIs
Publication statusPublished - 2013 Oct 3

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Myocardial Infarction
Magnetic Resonance Imaging
Electrocardiography
Wounds and Injuries
Exercise Test
ROC Curve
Area Under Curve
Cicatrix
Sensitivity and Specificity

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

@article{e49d82ab49b44807bc3793ae110356a6,
title = "Fragmented QRS complexes are not hallmarks of myocardial injury as detected by cardiac magnetic resonance imaging in patients with acute myocardial infarction",
abstract = "Background Q waves on a 12-lead electrocardiography (ECG) are considered to be classic hallmarks of prior myocardial infarction. However, one study suggested that the fragmented QRS complex (fQRS) on ECG is a highly sensitive and specific marker of myocardial scarring on a nuclear stress test. The study aimed to investigate the diagnostic accuracy of fragmented QRS complexes compared with Q waves for myocardial injury detected by delayed contrast-enhanced cardiovascular magnetic resonance imaging (DE-CMRI) in subjects with acute myocardial infarction. Methods Electrocardiograms of 190 subjects with myocardial infarction who underwent DE-CMR were analyzed. fQRS was defined by the presence of an additional R wave (R″), or notching of the S wave, or more than one R′ in two contiguous leads. Results Delayed enhancement was observed in 180 (94.7{\%}) patients. Transmural enhancement was noted in 78 (43.3{\%}) and subendocardial enhancement in 102 (56.7{\%}) patients. The sensitivity and specificity of Q waved and fQRS for diagnosing delayed enhancement were 59.4{\%} vs. 66.7{\%} and 90.0{\%} vs. 40.0{\%}. The area under the receiver-operator characteristics curve of delayed enhancement was 0.75 for Q waves and 0.53 for fQRS (p = 0.04). The areas under the ROC curves of the transmurality of delayed enhancement were 0.44 for fQRS and 0.58 for Q waves (p = 0.73). Conclusions fQRS has poor accuracy for the detection of myocardial injury compared with Q waves. fQRS and Q waves are not valuable tools for the diagnosis transmural irreversible myocardial injury in acute myocardial infarction.",
author = "Ahn, {Min Soo} and Kim, {Jin Bae} and Yoo, {Byung Su} and Lee, {Jun Won} and Lee, {Ji Hyun} and Youn, {Young Jin} and Ahn, {Sung Gyun} and Kim, {Jang Young} and Lee, {Seung Hwan} and Junghan Yoon and Choe, {Kyung Hoon}",
year = "2013",
month = "10",
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doi = "10.1016/j.ijcard.2012.12.086",
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TY - JOUR

T1 - Fragmented QRS complexes are not hallmarks of myocardial injury as detected by cardiac magnetic resonance imaging in patients with acute myocardial infarction

AU - Ahn, Min Soo

AU - Kim, Jin Bae

AU - Yoo, Byung Su

AU - Lee, Jun Won

AU - Lee, Ji Hyun

AU - Youn, Young Jin

AU - Ahn, Sung Gyun

AU - Kim, Jang Young

AU - Lee, Seung Hwan

AU - Yoon, Junghan

AU - Choe, Kyung Hoon

PY - 2013/10/3

Y1 - 2013/10/3

N2 - Background Q waves on a 12-lead electrocardiography (ECG) are considered to be classic hallmarks of prior myocardial infarction. However, one study suggested that the fragmented QRS complex (fQRS) on ECG is a highly sensitive and specific marker of myocardial scarring on a nuclear stress test. The study aimed to investigate the diagnostic accuracy of fragmented QRS complexes compared with Q waves for myocardial injury detected by delayed contrast-enhanced cardiovascular magnetic resonance imaging (DE-CMRI) in subjects with acute myocardial infarction. Methods Electrocardiograms of 190 subjects with myocardial infarction who underwent DE-CMR were analyzed. fQRS was defined by the presence of an additional R wave (R″), or notching of the S wave, or more than one R′ in two contiguous leads. Results Delayed enhancement was observed in 180 (94.7%) patients. Transmural enhancement was noted in 78 (43.3%) and subendocardial enhancement in 102 (56.7%) patients. The sensitivity and specificity of Q waved and fQRS for diagnosing delayed enhancement were 59.4% vs. 66.7% and 90.0% vs. 40.0%. The area under the receiver-operator characteristics curve of delayed enhancement was 0.75 for Q waves and 0.53 for fQRS (p = 0.04). The areas under the ROC curves of the transmurality of delayed enhancement were 0.44 for fQRS and 0.58 for Q waves (p = 0.73). Conclusions fQRS has poor accuracy for the detection of myocardial injury compared with Q waves. fQRS and Q waves are not valuable tools for the diagnosis transmural irreversible myocardial injury in acute myocardial infarction.

AB - Background Q waves on a 12-lead electrocardiography (ECG) are considered to be classic hallmarks of prior myocardial infarction. However, one study suggested that the fragmented QRS complex (fQRS) on ECG is a highly sensitive and specific marker of myocardial scarring on a nuclear stress test. The study aimed to investigate the diagnostic accuracy of fragmented QRS complexes compared with Q waves for myocardial injury detected by delayed contrast-enhanced cardiovascular magnetic resonance imaging (DE-CMRI) in subjects with acute myocardial infarction. Methods Electrocardiograms of 190 subjects with myocardial infarction who underwent DE-CMR were analyzed. fQRS was defined by the presence of an additional R wave (R″), or notching of the S wave, or more than one R′ in two contiguous leads. Results Delayed enhancement was observed in 180 (94.7%) patients. Transmural enhancement was noted in 78 (43.3%) and subendocardial enhancement in 102 (56.7%) patients. The sensitivity and specificity of Q waved and fQRS for diagnosing delayed enhancement were 59.4% vs. 66.7% and 90.0% vs. 40.0%. The area under the receiver-operator characteristics curve of delayed enhancement was 0.75 for Q waves and 0.53 for fQRS (p = 0.04). The areas under the ROC curves of the transmurality of delayed enhancement were 0.44 for fQRS and 0.58 for Q waves (p = 0.73). Conclusions fQRS has poor accuracy for the detection of myocardial injury compared with Q waves. fQRS and Q waves are not valuable tools for the diagnosis transmural irreversible myocardial injury in acute myocardial infarction.

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U2 - 10.1016/j.ijcard.2012.12.086

DO - 10.1016/j.ijcard.2012.12.086

M3 - Article

C2 - 23336958

AN - SCOPUS:84885612371

VL - 168

SP - 2008

EP - 2013

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

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