Key result
Anterior/lateral fragmented QRS in HFpEF linked to ~90% higher heart failure readmission risk.
Why the study?
Fragmented QRS confers higher risk in reduced ejection fraction heart failure, but its pathophysiological correlates and prognostic implications in HFpEF remained to be investigated.
Does the presence of fragmented QRS predict adverse outcomes in patients with HFpEF?
Cohort (n=960)
Does the presence of fragmented QRS predict adverse outcomes in patients with HFpEF?
Effect estimate: adjusted HR 1.90
p-value: p=<0.001
The presence of fragmented QRS, particularly anterior/lateral fQRS, in patients with HFpEF is associated with worse cardiac mechanics, perfusion defects, and significantly higher risks of HF readmission and mortality.
May support closer monitoring in HFpEF with anterior/lateral fQRS; extends ECG prognostic markers but remains hypothesis-generating.
Background Fragmented QRS (fQRS) morphology as a surrogate marker of the possible presence of myocardial scarring has been shown to confer a higher risk in patients with reduced ejection fraction heart failure. We aimed to investigate the pathophysiological correlates and prognostic implications of fQRS in patients with heart failure with preserved ejection fraction (HFpEF). Methods and Results We consecutively studied 960 patients with HFpEF (76.4±12.7 years, men: 37.2%). fQRS was assessed using a body surface ECG during hospitalization. QRS morphology was available and classified into 3 categories among 960 subjects with HFpEF as non‐fQRS, inferior fQRS, and anterior/lateral fQRS groups. Despite comparable clinical features in most baseline demographics among the 3 fQRS categories, anterior/lateral fQRS showed significantly higher B‐type natriuretic peptide/troponin levels (both P <0.001), with both the inferior and anterior/lateral fQRS HFpEF groups demonstrating a higher degree of unfavorable cardiac remodeling, greater extent of myocardial perfusion defect, and slower coronary flow phenomenon (all P <0.05). Patients with anterior/lateral fQRS HFpEF exhibited significantly altered cardiac structure/function and more impaired diastolic indices (all P <0.05). During a median of 657 days follow‐up, the presence of anterior/lateral fQRS conferred a doubled HF re‐admission risk (adjusted hazard ratio 1.90, P <0.001), with both inferior and anterior/lateral fQRS having a higher risk of cardiovascular and all‐cause death (all P <0.05) by using Cox regression models. Conclusions The presence of fQRS in HFpEF was associated with more extensive myocardial perfusion defects and worsened mechanics, which possibly denotes a more severe involvement of cardiac damage. Early recognition in such patients with HFpEF likely benefits from targeted therapeutic interventions.
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Sung et al. (2023) conducted a cohort in Heart failure with preserved ejection fraction (HFpEF) (n=960). Fragmented QRS (fQRS) morphology vs. Non-fQRS was evaluated on Heart failure re-admission risk (adjusted HR 1.90, p=<0.001). The presence of anterior/lateral fragmented QRS in patients with HFpEF was associated with a doubled risk of heart failure readmission (adjusted HR 1.90, P<0.001) over a median 657 days follow-up.
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