The Implication of a Fragmented QRS Complex in Patients with High Risk of Ischemic Heart Disease

Background: Fragmented QRS (fQRS) on a 12-lead ECG represents myocardial scar in patients with known or suspected coronary artery disease and is also an independent predictor of mortality. However, the implication of the fQRS has not been known in high risk patients who undergo vascular surgery with high risk for postoperative cardiac events. Methods: A total of 431 consecutive patients (69.6±10.0 years; 370 males) who underwent nuclear stress test for noncardiac vascular surgery were studies. Results: The fQRS was present in 162 (37.6%) patients and myocardial scar and/or ischemia was present in 90 (20.9%) patients. The sensitivity, specificity, positive predictive value, and negative predictive value of fQRS for diagnosing myocardial scar and/or ischemia were 64.4%, 69.5%, 35.8%, and 88.1%, respectively. The fQRS (Odds ratio 3.404, 95% confidence interval 1.91 to 6.06, p<0.001) was associated with myocardial scar and/or ischemia after adjusting for age, Q wave, histories of ischemic heart disease (IHD), heart failure, and cerebrovascular disease. Conclusion: The fQRS is an independent predictor for myocardial scar and/or ischemia in patients with high risk of IHD. Large studies are needed to evaluate the implication of fQRS in patients with high risk of IHD.