Year 2019, Volume 5, Issue 2, Pages 291 - 298 2019-03-04

Efficacy of adjunctive treatment with trimetazidine for fragmented QRS among patients with ischemic heart failure: a propensity score match analysis

Selçuk Kanat [1] , Barış Şensoy [2]

30 213

Objectives: Fragmented QRS (fQRS) is an indicator of nonhomogeneous ventricular activity caused by myocardial ischemia and fibrosis. The anti-ischemic agent trimetazidine (TMZ) added to pharmacological treatment appears to have positive effects on cardiac parameters of patients with ischemic heart failure. We aimed to investigate the relationship of fQRS with adjunctive TMZ therapy in ischemic HF patients.

Methods: Four hundred eighty-nine consecutive ambulatory ischemic patients with heart failure eligible for our study were recruited for the study. A 12-lead electrocardiogram with standard chest and limb leads was used to evaluate the presence of fQRS. Further patients were divided into groups according to adjunctive TMZ treatment and fQRS presence. Confounding factors were adjusted by propensity score matching and multivariate logistic regression analysis.

Results: One hundred ninety-seven (40.3%) patients had fQRS on their ECGs and 235 (48.1%) patients were on adjunctive treatment with trimetazidine. Compared to patients without fQRS, patients with fQRS had lower left ventricular ejection fraction (LVEF), higher NYHA classes and more frequent mineralocorticoid receptor antagonist and diuretic usage (p < 0.05). Add-on treatment with TMZ was independently associated with fQRS presence (OR, 0.45; (95% CI, 0.29-0.70); p < 0.0001).

Conclusion: According to conventional therapy, adjunctive treatment with TMZ among ischemic heart failure patients can be associated with fQRS in 12-lead ECG independent of LVEF.

Adjunctive treatment, fragmented QRS, ischemic heart failure, myocardial fibrosis, trimetazidine
  • [26] Celikyurt U, Agacdiken A, Sahin T, Al N, Kozdag G, Vural A, et al. Number of leads with fragmented QRS predicts response to cardiac resynchronization therapy. Clin Cardiol 2013;36:36-9.
  • [1] Grajek S, Michalak M. The effect of trimetazidine added to pharmacological treatment on all-cause mortality in patients with systolic heart failure. Cardiology 2015;131:22-9.
  • [2] Sensoy B, Canpolat U, Cay S, Ozeke O, Acikgoz K, Kus O, et al. Treatment of mechanical valve thrombosis in the right heart: overview of the requirements for the new thrombolytic protocols. Blood Coagul Fibrinolysis 2015;26:220-2.
  • [27] Torigoe K, Tamura A, Kawano Y, Shinozaki K, Kotoku M, Kadota J. The number of leads with fragmented QRS is independently associated with cardiac death or hospitalization for heart failure in patients with prior myocardial infarction. J Cardiol 2012;59:36-41.
  • [3] Tang WH. The metabolic approach in patients with heart failure: effects on left ventricle remodeling. Curr Pharm Des 2009;15:850-6.
  • [4] Fragasso G, Salerno A, Spoladore R, Bassanelli G, Arioli F, Margonato A. Metabolic therapy of heart failure. Curr Pharm Des 2008;14:2582-91.
  • [5] Lionetti V, Stanley WC, Recchia FA. Modulating fatty acid oxidation in heart failure. Cardiovasc Res 2011;90:202-9.
  • [6] Belardinelli R, Solenghi M, Volpe L, Purcaro A. Trimetazidine improves endothelial dysfunction in chronic heart failure: an antioxidant effect. Eur Heart J 2007;28:1102-8.
  • [7] El-Kady T, El-Sabban K, Gabaly M, Sabry A, Abdel-Hady S. Effects of trimetazidine on myocardial perfusion and the contractile response of chronically dysfunctional myocardium in ischemic cardiomyopathy: a 24-month study. Am J Cardiovasc Drugs 2005;5:271-8.
  • [8] Cera M, Salerno A, Fragasso G, Montanaro C, Gardini C, Marinosci G, et al. Beneficial electrophysiological effects of trimetazidine in patients with postischemic chronic heart failure. J Cardiovasc Pharmacol Ther 2010;15:24-30.
  • [9] Korhonen P, Husa T, Konttila T, Tierala I, Makijarvi M, Vaananen H, et al. Fragmented QRS in prediction of cardiac deaths and heart failure hospitalizations after myocardial infarction. Ann Noninvasive Electrocardiol 2010;15:130-7.
  • [10] Das MK, Saha C, El Masry H, Peng J, Dandamudi G, Mahenthiran J, et al. Fragmented QRS on a 12-lead ECG: a predictor of mortality and cardiac events in patients with coronary artery disease. Heart Rhythm 2007;4:1385-92.
  • [11] 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;113:2495-501.
  • [12] Mahenthiran J, Khan BR, Sawada SG, Das MK. Fragmented QRS complexes not typical of a bundle branch block: a marker of greater myocardial perfusion tomography abnormalities in coronary artery disease. J Nucl Cardiol 2007;14:347-53.
  • [13] Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005;18:1440-63.
  • [14] Rubin DB. The design versus the analysis of observational studies for causal effects: parallels with the design of randomized trials. Stat Med 2007;26:20-36.
  • [15] McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 2012;33:1787-847.
  • [16] Das MK, El Masry H. Fragmented QRS and other depolarization abnormalities as a predictor of mortality and sudden cardiac death. Curr Opin Cardiol 2010;25:59-64.
  • [17] Ozdemir S, Tan YZ, Colkesen Y, Temiz A, Turker F, Akgoz S. Comparison of fragmented QRS and myocardial perfusion-gated SPECT findings. Nucl Med Commun 2013;34:1107-15.
  • [18] Cetin M, Kocaman SA, Kiris T, Erdogan T, Canga A, Durakoglugil ME, et al. Absence and resolution of fragmented QRS predict reversible myocardial ischemia with higher probability of ST segment resolution in patients with ST segment elevation myocardial infarction. Korean Circ J 2012;42:674-83.
  • [19] Ozcan S, Cakmak HA, Ikitimur B, Yurtseven E, Stavileci B, Tufekcioglu EY, et al. The prognostic significance of narrow fragmented QRS on admission electrocardiogram in patients hospitalized for decompensated systolic heart failure. Clin Cardiol 2013;36:560-4.
  • [20] Cheema A, Khalid A, Wimmer A, Bartone C, Chow T, Spertus JA, et al. Fragmented QRS and mortality risk in patients with left ventricular dysfunction. Circ Arrhythm Electrophysiol 2010;3:339-44.
  • [21] Sha J, Zhang S, Tang M, Chen K, Zhao X, Wang F. Fragmented QRS is associated with all-cause mortality and ventricular arrhythmias in patient with idiopathic dilated cardiomyopathy. Ann Noninvasive Electrocardiol 2011;16:270-5.
  • [22] John RM, Tedrow UB, Koplan BA, Albert CM, Epstein LM, Sweeney MO, et al. Ventricular arrhythmias and sudden cardiac death. Lancet 2012;380:1520-9.
  • [23] Belardinelli R, Cianci G, Gigli M, Mazzanti M, Lacalaprice F. Effects of trimetazidine on myocardial perfusion and left ventricular systolic function in type 2 diabetic patients with ischemic cardiomyopathy. J Cardiovasc Pharmacol 2008;51:611-5.
  • [24] 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;1:258-68.
  • [25] Ozcan F, Turak O, Canpolat U, Avci S, Tok D, Isleyen A, et al. Fragmented QRS predicts the arrhythmic events in patients with heart failure undergoing ICD implantation for primary prophylaxis: more fragments more appropriate ICD shocks. Ann Noninvasive Electrocardiol 2014;19:351-7.
Primary Language en
Subjects Health Care Sciences and Services
Journal Section Original Articles
Authors

Orcid: 0000-0002-1211-6532
Author: Selçuk Kanat (Primary Author)
Institution: Department of Cardiology, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
Country: Turkey


Orcid: 0000-0003-0066-9946
Author: Barış Şensoy
Institution: Department of Cardiology, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
Country: Turkey


Dates

Publication Date: March 4, 2019

EndNote %0 The European Research Journal Efficacy of adjunctive treatment with trimetazidine for fragmented QRS among patients with ischemic heart failure: a propensity score match analysis %A Selçuk Kanat , Barış Şensoy %T Efficacy of adjunctive treatment with trimetazidine for fragmented QRS among patients with ischemic heart failure: a propensity score match analysis %D 2019 %J The European Research Journal %P -2149-3189 %V 5 %N 2 %R doi: 10.18621/eurj.397369 %U 10.18621/eurj.397369