The prognostic role of fragmented QRS complex in acute myocarditis

Aim: Although a fulminant course of the myocarditis is difficult to predict, it may lead to acute heart failure and death. Previous studies have demonstrated that reduced left ventricular systolic function and prolonged QRS duration can predict the fulminant course. This study aimed to identify whether fragmented QRS complex (fQRS) could also be predictive of fulminant disease in this population. Material and Methods: We retrospectively included 156 patients diagnosed with acute myocarditis. They were divided into the fulminant group (n = 18) and the non-fulminant group (n = 138). Multivariate logistic regression analysis was used to identify the independent factors predictive of fulminant disease. Results: Fragmented QRS developed in 11 (61%) in the fulminant group and only 10 patients (7%) in the non-fulminant group (p <0.001). Patients with fulminant myocarditis had a higher mortality rate than those with non-fulminant disease (44.6% vs. 0%, p < 0.001). Multivariate analysis revealed that the presence of fQRS (p=0.019), longer Tpe/qt ratio (p=0.022) and clinical heart failure (<0.001) were significant predictors associated with a fulminant course of myocarditis. Conclusion: The presence of fQRS complex, as a simple and feasible electrocardiographic marker, seems to be a novel predictor fulminant myocarditis. This simpleparameter may be used in identifying patients at high risk for fulminancy and so early mechanical support could provide improved patient outcomes.