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July 10, 2026BMC Cardiovascular DisordersOpen Access

Preoperative fragmented QRS as a predictor of postoperative left ventricular systolic dysfunction after isolated mitral valve replacement

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Why the study?

Many patients develop postoperative LV systolic dysfunction after mitral valve surgery despite preserved preoperative LVEF. This study evaluated whether preoperative fragmented QRS predicts postoperative LV systolic dysfunction after isolated mitral valve replacement.

Does preoperative fragmented QRS predict postoperative left ventricular systolic dysfunction in patients undergoing isolated mitral valve replacement for chronic mitral regurgitation?

Population

279 consecutive patients undergoing elective isolated mitral valve replacement for chronic mitral regurgitation

Comparison

Preoperative fQRS vs no fQRS

Design

Retrospective cohort study

Key result

Preoperative fragmented QRS was associated with higher postoperative LV systolic dysfunction (45.1% vs 28.8%), though the adjusted association narrowly missed significance (OR 1.90; p=0.052).

Authors

İBİsmail BalabanSTSeda TanyeriAKAhmet Karaduman

Discussion

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Overview

Preoperative fQRS signals possible risk of postoperative LV dysfunction after mitral valve replacement; leaves open its role in risk stratification pending prospective validation.

Key Points

  • This study aims to assess the prognostic value of preoperative fragmented QRS for predicting postoperative left ventricular systolic dysfunction following mitral valve surgery.
  • 279 patients undergoing elective isolated mitral valve replacement analyzed retrospectively between January 2022 and June 2025.
  • Fragmented QRS assessed via preoperative 12-lead electrocardiography.
  • Multivariable logistic regression with exploratory backward stepwise approach was used for analyses.
  • Postoperative LV systolic dysfunction occurred in 92 of 279 patients (33.0%).
  • Patients with fQRS had a higher incidence of postoperative LV systolic dysfunction (45.1% vs. 28.8%; p = 0.012).
  • In the exploratory model, preoperative fQRS was significantly associated with postoperative LV dysfunction (OR 2.00, 95% CI 1.06–3.81; p = 0.033).

Study Design

Type

Cohort (n=279)

Structured PICO

Does preoperative fragmented QRS predict postoperative left ventricular systolic dysfunction in patients undergoing isolated mitral valve replacement for chronic mitral regurgitation?

P
Population
279 patients undergoing elective isolated mitral valve replacement for chronic mitral regurgitation, evaluated for early postoperative LV systolic dysfunction.
E
Exposure
Presence of preoperative fragmented QRS (fQRS) on 12-lead electrocardiography
C
Comparator
Absence of preoperative fragmented QRS
O
Outcome
Postoperative left ventricular (LV) systolic dysfunction (defined as LVEF < 50% on early postoperative echocardiography)surrogate

Main Result

Odds Ratio: 1.9 (95% CI 0.99–3.64)

Absolute Event Rate: 45.1% vs 28.8%

p-value: p=0.052

Preoperative fragmented QRS on a standard 12-lead ECG may serve as a simple, non-invasive marker to help predict the risk of postoperative left ventricular systolic dysfunction in patients undergoing mitral valve replacement.

Limitations

  • Requires validation in larger prospective cohorts before clinical implementation
  • Requires validation in larger prospective cohorts

Cite This Study

Balaban et al. (2026) conducted a cohort in Chronic mitral regurgitation (n=279). Preoperative fragmented QRS vs. No preoperative fragmented QRS was evaluated on Postoperative LV systolic dysfunction (LVEF < 50% on early postoperative echocardiography) (OR 1.90, 95% CI 0.99-3.64, p=0.052). Preoperative fragmented QRS was associated with higher postoperative LV systolic dysfunction (45.1% vs 28.8%), though the adjusted association narrowly missed significance (OR 1.90; p=0.052).

synapsesocial.com/papers/6a5090016eeac72a437a185chttps://doi.org/10.1186/s12872-026-06266-x
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