Clinical significance of fragmented QRS in relation to left ventricular mass and carotid intima-media thickness in hypertensive individuals
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
Destekleyen Kurum
Bu çalışma için herhangi bir mali destek alınmamıştır.
Etik Beyan
Hitit Üniversitesi Klinik Araştırmalar Etik Kurulu’nun 13.11.2019 tarihli ve 2019/85 sayılı kararı ile etik onay alınmıştır.
Teşekkür
Çalışmada emeği geçen tüm kurum çalışanlarımıza teşekkür ederiz.
Kaynakça
- Taki H, Tuomilehto J, Zimmet P, Tamosiunas A, Kowlessur S, Magliano DJ et al. Left ventricular hypertrophy: an ECG-based study of prevalence and risk factors in a multiethnic population. Open Heart. 2023;10:e002495.
- Han Y, Li Y, Wu Z, Pei Y, Lu S, Yu H et al. Progress in diagnosis and treatment of hypertension combined with left ventricular hypertrophy. Ann Med. 2024;56:2405080.
- Kruszewska J, Cudnoch-Jedrzejewska A, Czarzasta K. Remodeling and fibrosis of the cardiac muscle in the course of obesity-pathogenesis and involvement of the extracellular matrix. Int J Mol Sci. 2022;23:4195.
- Khalid K, Padda J, Ismail D, Abdullah M, Gupta D, Pradeep R, et al. Correlation of coronary artery disease and left ventricular hypertrophy. Cureus. 2021;13:e17550.
- AlGhibiwi HK, Sarawi WS, Alosaimi ME, Alhusaini AM, Assiri MA, Algarzae NK. The Association between cardiovascular risk factors and carotid intima-media thickness in 42,726 adults in UK biobank: a cross-sectional study. J Cardiovasc Dev Dis. 2023;10:358.
- Yang T, Fu X, Fu P, Chen J, Xu C, Liu X et al. The value of fragmented QRS in predicting the prognosis of chronic total occlusion patients with myocardial infarction history undergoing percutaneous coronary intervention: a 24-months follow-up study. Clin Cardiol. 2021;44:537-46.
- Younis AS, El-Halag MI, 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;72:43.
- Bekar L, Katar M, Yetim M, Çelik O, Kilci H, Önalan O. Fragmented QRS complexes are a marker of myocardial fibrosis in hypertensive heart disease. Turk Kardiyol Dern Ars. 2016;44:554-60.
- Güçlü A, Kahraman S, Kırış A, Arı H, Akyüz A, Yıldız A. Relationship between fragmented QRS complex and aortic stiffness in chronic hemodialysis patients. Anatol J Cardiol. 2017;17:128-33.
- Şahin S, Aslan AN, Kocaman SA, Baysan O, Uğurlu Y, Cengel A. Relation between fragmented QRS complex and arterial compliance in hypertensive patients. Eurasian J Med. 2019;51:145-50.
