Clinical significance of fragmented QRS in relation to left ventricular mass and carotid intima-media thickness in hypertensive individuals

Yıl 2025, Cilt: 50 Sayı: 4, 1073 - 1083, 22.12.2025

Mucahit Yetim , Macit Kalçık , Lütfü Bekar , Muhammet Cihat Çelik , Yusuf Karavelioğlu

https://doi.org/10.17826/cumj.1785525

Öz

Purpose: Fragmented QRS (fQRS) is an electrocardiographic marker of depolarization abnormalities related to myocardial fibrosis. Although fQRS has been linked to adverse cardiovascular outcomes, its relationship with vascular remodeling in hypertension remains unclear. This study aimed to investigate the association between fQRS, left ventricular hypertrophy (LVH), and carotid artery disease in hypertensive patients.
Materials and Methods: A total of 292 patients with essential hypertension were enrolled and stratified into two groups according to the presence (n = 128) or absence (n = 164) of fQRS on 12-lead electrocardiography. All participants underwent transthoracic echocardiography to determine left ventricular mass (LVM) and left ventricular mass index (LVMI), as well as carotid ultrasonography for measurement of carotid intima-media thickness (CIMT) and plaque detection.
Results: Baseline demographic and laboratory parameters, including lipid profile and inflammatory markers, did not differ significantly between groups. However, patients with fQRS exhibited higher systolic and diastolic blood pressure, greater LVM and LVMI, and a markedly increased prevalence of LVH (60.9% vs. 14.6%). Carotid ultrasound revealed significantly higher CIMT values (Right: 0.87 vs. 0.71; Left: 0.86 vs. 0.70) and plaque burden (32.8% vs. 11%) in the fQRS group. Multivariable analysis identified right CIMT >0.72 mm, left CIMT >0.74 mm, LVM >145 g, LVMI >91 g/m², and carotid plaque presence as independent associates of fQRS.
Conclusion: Fragmented QRS is strongly associated with both myocardial and vascular target-organ damage in hypertension. Its presence may serve as a non-invasive marker for identifying high-risk patients who warrant intensified cardiovascular risk assessment and management.

Anahtar Kelimeler

Fragmented QRS , Hypertension , Left ventricular hypertrophy , Carotid intima-media thickness , Carotid plaque

Etik Beyan

Ethical approval was obtained from the Clinical Research Ethics Committee of Hitit University by its decision dated 13.11.2019 and numbered 2019/85.

Destekleyen Kurum

No financial funding was received for this study.

Teşekkür

We thank all the staff of the institution who contributed to the study.

Hipertansif bireylerde sol ventrikül kütlesi ve karotis intima-media kalınlığı ile ilişkili olarak fragmente QRS’nin klinik önemi

Öz

Amaç: Fragmente QRS (fQRS), miyokardiyal fibrozis ile ilişkili depolarizasyon anormalliklerinin elektrokardiyografik bir göstergesidir. fQRS’nin olumsuz kardiyovasküler sonuçlarla ilişkisi gösterilmiş olsa da hipertansiyonda vasküler yeniden yapılanma ile ilişkisi belirsizdir. Bu çalışma, hipertansif hastalarda fQRS’nin sol ventrikül hipertrofisi (SVH) ve karotis arter hastalığı ile ilişkisini araştırmayı amaçladı.
Gereç ve Yöntem: Esansiyel hipertansiyonu olan toplam 292 hasta çalışmaya alındı ve 12 derivasyonlu elektrokardiyografide fQRS varlığına (n = 128) veya yokluğuna (n = 164) göre iki gruba ayrıldı. Tüm katılımcılara sol ventrikül kütlesi (LVK) ve sol ventrikül kütle indeksi (LVKI) ölçümü için transtorasik ekokardiyografi, karotis intima-media kalınlığı (KİMK) ve plak varlığını belirlemek için karotis ultrasonografisi uygulandı.
Bulgular: Demografik ve laboratuvar parametreleri, lipit profili ve inflamatuvar belirteçler dahil olmak üzere, gruplar arasında anlamlı farklılık göstermedi. Ancak fQRS pozitif hastalarda sistolik ve diyastolik kan basıncı daha yüksek, LVK ve LVKI daha fazla ve SVH prevalansı belirgin derecede artmıştı (%60,9’a karşı %14,6). Karotis ultrasonografisi, fQRS grubunda anlamlı derecede daha yüksek KİMK değerleri (Sağ: 0,87’ye karşı 0,71; Sol: 0,86’ya karşı 0,70) ve plak yükü (%32,8’e karşı %11)ortaya koydu. Çok değişkenli analizde sağ KİMK >0,72 mm, sol KİMK >0,74 mm, LVK >145 g, LVKI >91 g/m² ve karotis plak varlığı fQRS’nin bağımsız olarak ilişkili değişkenler olarak bulundu.
Sonuç: Fragmented QRS, hipertansiyonda hem miyokard hem de vasküler hedef organ hasarı ile güçlü şekilde ilişkilidir. Varlığı, kardiyovasküler risk değerlendirmesi ve yönetimi yoğunlaştırılması gereken yüksek riskli hastaları tanımlamada non-invaziv bir belirteç olarak kullanılabilir.

Anahtar Kelimeler

Fragmente QRS , Hipertansiyon , Sol ventrikül hipertrofisi , Karotis intima-media kalınlığı , Karotis plak

Etik Beyan

Hitit Üniversitesi Klinik Araştırmalar Etik Kurulu’nun 13.11.2019 tarihli ve 2019/85 sayılı kararı ile etik onay alınmıştır.

Destekleyen Kurum

Bu çalışma için herhangi bir mali destek alınmamıştır.

Teşekkür

Çalışmada emeği geçen tüm kurum çalışanlarımıza teşekkür ederiz.

Kaynakça

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