RELATION BETWEEN FRAGMENTED QRS COMPLEX AND ARTERIAL COMPLIANCE IN ASYMPTOMATIC HYPERTENSIVE PATIENTS

Abstract

Objective: Decreased arterial compliance is among the earliest detectable findings of adverse structural and functional changes in the vessel wall and it results in stiffened arteries. The goal of this study was to explore the relationship between fragmented QRS in electocardiogram and arterial compliance.

Material and Methods: Eighty asymptomatic hypertensive patients with fragmented QRS (40 male, mean age: 58±8/years) and 80 age-gender matched control subjects without fragmented QRS (39 male, mean age: 57±9/years) were enrolled. Arterial compliance was calculated as stroke volume to pulse pressure ratio and adjusted to body surface area to calculate the stroke volume to pulse pressure index. The fragmented QRS complexes were investigated in the 12-lead electrocardiogram.

Results: Patients wih fragmented QRS had significantly lower arterial compliance (0.71±0.29 mL/m2/mmHg versus 0.93±0.32 mL/m2/mmHg; p<0.001). A univariate analysis showed a significant correlation between decreased arterial compliance and fragmented QRS, age, and calcium channel blocker use. Multivariable analysis demonstrated age (95%CI): 0697-0.830; p<0.001) and fragmented QRS (95%CI): 0.06-0.536; p=0.002) as independent determinants of reduced arterial compliance.

Conclusion: The avaliability of fragmented QRS in electrocardiogram may have significant predictive information of arterial compliance in hypertensive subjects.

Keywords

• Arterial Compliance
• Fragmented QRS
• Hypertension

Asemptomatik Hipertansif Hastalarda Parçalanmış QRS Kompleksi ile Arteryel Komplians Arasındaki İlişki

Abstract

Amaç: Azalmış arteryel komplians, damar duvarındaki olumsuz yapısal ve fonksiyonel değişikliklerin en erken tespit edilebilen bulgusudur ve ilerleyen zamanda damar sertliği ile sonuçlanır. Bu çalışmanın amacı, elektrokardiyogramdaki parçalanmış QRS ile arteryel uyum arasındaki ilişkiyi araştırmaktır.

Gereç ve Yöntemler: Parçalanmış QRS’li 80 asemptomatik hipertansif hasta (40 erkek, ortalama yaş: 58±8/yıl) ve parçalanmış QRS’siz 80 yaş-cinsiyet eşleştirilmiş kontrol deneği (39 erkek, ortalama yaş: 57±9/yıl) çalışmaya kaydedildi. Arteryel komplians, vuruş hacmi/nabız basıncı oranı olarak hesaplandı ve vuruş hacmi/nabız basıncı indeksini hesaplamak için vücut yüzey alanına göre ayarlandı. Parçalanmış QRS kompleksleri 12 kanallı elektrokardiyogramda incelendi.

Bulgular: Parçalanmış QRS’li hastalar anlamlı olarak daha düşük arteryel kompliansa sahipti (0.71±0.29 mL/m2/mmHg’ye karşı 0.93±032 mL/m2/mmHg; p<0.001). Tek değişkenli analiz, azalmış arteryel komplians ile parçalanmış QRS, yaş ve kalsiyum kanal bloker kullanımı arasında anlamlı bir korelasyon gösterdi. Çoklu ikili lojistik regresyon analizi, azalmış arteryel kompliansın bağımsız belirleyicileri olarak yaşı (%95CI): 0697-0.830; p <0.001) ve parçalanmış QRS’i (%95CI): 0.06-0.536; p=0.002) göstermiştir.

Sonuç: Parçalanmış QRS’in elektrokardiyogramda bulunması, hipertansif hastalarda arteryel komplians ile ilgili önemli prediktif bilgi sağlayabilir.

Keywords

• Arteryel Komplians
• Parçalanmış QRS
• Hipertansiyon

References

1. 1. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Prospective Studies Collaboration Age specific relevance of usual blood pressure to vascular mortality. Lancet. 2002;360(9349):1903-13.
2. 2. Haluska BA, Jeffries L, Carlier S, Marwick TH. Measurement of arterial distensibility and compliance to assess prognosis. Atherosclerosis. 2010;209(2):474-80.
3. 3. Avolio AP, Kuznetsova T, Heyndrickx GR, Kerkhof PLM, Li JK. Arterial flow, pulse pressure and pulse wave velocity in men and women at various ages. Adv Exp Med Biol. 2018;1065:153-68.
4. 4. Pannier BM, Avolio AP, Hoeks A, Mancia G, Takazawa K. Methods and devices for measuring arterial compliance in humans. Am J Hypertens. 2002;15(8):743-53.
5. 5. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G et al. 2007 guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2007;25(6):1105-87.
6. 6. Mohty D, Pibarot P, Echahidi N, Poirier P, Dagenais GR, Dumesnil JG. Reduced systemic arterial compliance measured by routine Doppler echocardiography: a new and independent predictor of mortality in patients with type 2 diabetes mellitus. Atherosclerosis. 2012;225(2):353-8.
7. 7. Oliver JJ, Webb DJ. Noninvasive assesment of arterial stiffness and risk of atherosclerotic events. Arterioscler Thromb Vasc Bio. 2003;23(4):554-66.
8. 8. De Simone G, Roman MJ, Koren MJ, Mensah GA, Ganau A, Devereux RB. Stroke volume/pulse pressure ratio and cardiovascular risk in arterial hypertension. Hypertension. 1999;33(3):800-5.

9. 9. Borlaug BA, Kass DA. Ventricular-vascular interaction in heart failure. Cardiol Clin. 2011;29(3):447-59.
10. 10. Bell V, Sigurdsson S, Westenberg JJ, Gotal JD, Torjesen AA, Aspelund T et al. Relations between aortic stiffness and left ventricular structure and function in older participants in the Age, Gene/Environment Susceptibility--Reykjavik Study. Circ Cardiovasc Imaging. 2015;8(4):e003039.
11. 11. Ye Z, Coutinho T, Pellikka PA, Villarraga HR, Borlaug BA, Kullo IJ. Associations of alterations in pulsatile arterial load with left ventricular longitudinal strain. Am J Hypertens. 2015;28(11):1325-31.
12. 12. Otsuki T, Maeda S, Kesen Y, Yokohama N, Tanabe T, Sugawara J et al. Age-related reduction of systemic arterial compliance ınduces excessive myocardial oxygen consumption during sub-maximal exercise. Hypertens Res. 2006;29(2):65-73.
13. 13. Haluska BA, Matthys K, Fathi R, Rozis E, Carlier SG, Marwick TH. Influence of arterial compliance on presence and extent of ischemia during stress Echocardiography. Heart. 2006;92(1):40-3.
14. 14. Schillaci G, Battista F, Settimi L, Anastasio F, Pucci G. Cardio-ankle vascular index and subclinical heart disease. Hypertens Res. 2015;38(1):68-73.
15. 15. Havranek EP, Emsermann CD, Froshaug DN, Masoudi FA, Krantz MJ, Hanratty R et al. Thresholds in the relationship between mortality and left ventricular hypertrophy defined by electrocardiography. J Electrocardiol. 2008;41(4):342-50.
16. 16. Das MK, Khan B, Jacob S, Kumar A, Mahenthiran J. Significance of a fragmented QRS complex versus a Q wave in patients with coronary artery disease. Circulation. 2006;113(21):2495-501.
17. 17. Armstrong AC, Gidding S, Gjesdal O, Wu C, Bluemke DA, Lima JA. LV mass assessed by echocardiography and CMR, cardiovascular outcomes, and medical practice. JACC Cardiovasc Imaging 2012;5(8):837-48.
18. 18. Das MK, Suradi H, Maskoun W, Michael MA, Shen C, Peng J et al. Fragmented wide QRS on a 12-lead ECG: a sign of myocardial scar and poor prognosis. Circ Arrhythm Electrophysiol. 2008;1(4):258-68.
19. 19. Ozcan KS, Güngör B, Tatlısu MA, Osmonov D, Ekmekçi A, Çalık AN et al. Presence of early repolarization on admission electrocardiography is associated with long-term mortality and MACE in patients with STEMI undergoing primary percutaneous intervention. J Cardiol. 2014;64(3):164-70.
20. 20. Basaran Y, Tigen K, Karaahmet T, Isiklar I, Cevik C, Gurel E et al. Fragmented QRS complexes are associated with cardiac fibrosis and significant intraventricular systolic dyssynchrony in nonischemic dilated cardiomyopathy patients with a narrow QRS interval. Echocardiography. 2011;28(1):62-8.
21. 21. Younis AS, El-HalagMI, ElBadry MA, Abbas NIM. Fragmented QRS complex frequency and location as predictor of cardiogenic shock and mortality following acute coronary syndrome. Egypt Heart J. 2020;72(1):43.
22. 22. Akyuz AR, Sahin S, Cirakoğlu OF, Kul S, Turan T, Erkan H. Relation between fragmented QRS complex and cardio-ankle vascular index in asymptomatic subjects. Clin Exp Hypertens. 2021;43(4):368-72.
23. 23. Bonakdar H, Moladoust H, Kheirkhah J, Abbaspour E, Assadian Rad M, Salari A et al. Significance of a fragmanted QRS complex in patients with chronic total occlusion of coronary artery without prior myocardial infarction. Anatol J Cardiol. 2016;16(2):106-12.