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September 3, 2026Cardiology ResearchOpen Access

Fragmented QRS on Baseline Electrocardiography Predicts Anatomically Significant Stenosis in Patients With Intermediate Coronary Lesions on Coronary Computed Tomography Angiography

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Why the study?

Intermediate stenosis on CCTA creates diagnostic uncertainty regarding the necessity of ICA, and the predictive value of fragmented QRS remains unclear in this cohort.

Does the presence of fragmented QRS on baseline ECG predict anatomically severe stenosis in patients with intermediate coronary lesions on CCTA?

Population

200 patients with CCTA-detected intermediate stenosis (40-70%) who underwent ICA

Comparison

Severe stenosis (>= 70%) vs non-severe stenosis (< 70%) on ICA

Design

Retrospective study

Key result

The presence of fragmented QRS on baseline ECG independently predicted anatomically severe coronary stenosis (≥ 70%) on invasive angiography with an odds ratio of 5.814.

Authors

ETEyyup TusunMMMehmet Han MercanMKMuslum Karakas

Discussion

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Overview

fQRS was associated with severe stenosis on ICA; leaves open its utility for guiding referrals in intermediate CCTA lesions.

Key Points

  • To determine whether fragmented QRS (fQRS) on baseline electrocardiography predicts anatomically severe coronary artery stenosis (≥70%) confirmed by invasive coronary angiography in patients with intermediate lesions on computed tomography.
  • Retrospectively analyzed 200 patients with intermediate stenosis (40–70%) on coronary computed tomography angiography who underwent subsequent invasive coronary angiography.
  • Stratified patients into severe (≥70%, n=89) and non-severe (<70%, n=111) stenosis cohorts and evaluated standard 12-lead ECGs using multivariable binary logistic regression and ROC curve analysis.
  • The prevalence of fQRS was significantly higher in patients with severe versus non-severe stenosis (65.2% vs. 16.2%, P < 0.001).
  • Multivariate regression identified fQRS as an independent predictor of severe stenosis (OR: 5.814, 95% CI: 2.478–13.645, P < 0.001), along with male sex (OR: 4.167, 95% CI: 1.798–9.655, P = 0.001) and hyperlipidemia (OR: 2.342, 95% CI: 1.106–4.959, P = 0.026).
  • ROC analysis showed moderate diagnostic accuracy for fQRS (AUC: 0.745, 95% CI: 0.673–0.816, P < 0.001), with a sensitivity of 65.2% and a specificity of 83.8%.

Study Design

Type

Cross-Sectional (n=200)

Multicenter

No

Structured PICO

Does the presence of fragmented QRS on baseline ECG predict anatomically severe stenosis in patients with intermediate coronary lesions on CCTA?

P
Population
200 patients (mean age 58.4 years, 45.5% female) with CCTA-detected intermediate coronary stenosis (40-70%) who underwent subsequent invasive coronary angiography.
E
Exposure
Presence of fragmented QRS (fQRS) on baseline standard 12-lead electrocardiography (ECG)
C
Comparator
Absence of fragmented QRS (fQRS) on baseline standard 12-lead electrocardiography (ECG)
O
Outcome
Anatomically severe stenosis (≥ 70%) confirmed by invasive coronary angiography (ICA)surrogate

Main Result

Odds Ratio: 5.814 (95% CI 2.478–13.645)

Absolute Event Rate: 76.3% vs 25%

p-value: p=<0.001

The presence of fragmented QRS on a standard 12-lead ECG is a strong, independent predictor of anatomically severe coronary stenosis in patients with intermediate lesions on CCTA, offering a simple, non-invasive tool to help guide referral for invasive angiography.

Limitations

  • Retrospective, single-center design precludes establishing definitive causality and limits global generalizability
  • Verification bias due to enrolling only patients clinically referred for ICA based on symptom burden or positive stress tests
  • Absence of functional lesion assessments (e.g., FFR, iFR) prevents direct correlation with true ischemia
  • Moderate sensitivity (65.2%) suggests it should be used as an adjunctive tool rather than a sole diagnostic test
  • Ejection fraction (EF) could not be reliably assessed in this retrospective cohort
  • Optimal ROC cut-off point requires external validation in independent cohorts

Cite This Study

Tusun et al. (2026) conducted a cross-sectional in Intermediate coronary lesions on CCTA (n=200). Fragmented QRS (fQRS) on baseline ECG vs. Absence of fQRS was evaluated on Anatomically severe coronary stenosis (≥ 70%) on invasive coronary angiography (OR 5.814, 95% CI 2.478-13.645, p=<0.001). The presence of fragmented QRS on baseline ECG independently predicted anatomically severe coronary stenosis (≥ 70%) on invasive angiography with an odds ratio of 5.814.

synapsesocial.com/papers/6a9934cf636c6408cfa7c7efhttps://doi.org/10.14740/cr2284
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