Relationship Between Fragmented QRS Complex and Maternal Demographic Features and Echocardiographic Parameters in Pregnancy

Yıl 2020, Cilt: 10 Sayı: 1, 17 - 22, 16.03.2020

Veciha Özlem Bozkaya

https://doi.org/10.31832/smj.645580

Öz

Objective: The aim of this study was to investigate the
relationship between the presence of fragmented QRS (f-QRS) complex on
electrocardiography (ECG) and maternal demographic characteristics and left
ventricular systolic and diastolic dysfunction on echocardiography. Materials
and Methods: 473 pregnant women enrolled in this study and divided
into two groups. (f-QRS positive group n=77, f-QRS negative group n=396 ).
Maternal demographic features and echocardiographic parameters of all
participants were recorded and compared between two groups. Results: The mean age of the study population was 27.70 ± 5.62 and mean gestational week was 7.37 ±
1.55. Parity in f-QRS positive
group was higher than in control group (p=0.01). There was a statistically
significant trend between fragmentation frequency and parity number (p=0.002). There
were no significant differences between two groups in terms of age, gestational
week, heart rate, body mass index. Left ventricle end-systolic and diastolic
diameters and left ventricular ejection fraction were similar between the two
groups Conclusions:  The presence of f-QRS was correlated with increase in number
of parity and we suggest that multiparity may be a risk factor for cardiac
events during pregnancy. Pregnant women with f-QRS on their rest ECG need extra
attention in terms of cardiovascular disease. By demonstrating clinical
significance of f-QRS, this simple tool might be used to determine women who
could be at risk for developing cardiac dysfunction in pregnancy.

Anahtar Kelimeler

QRS fragmentation, pregnancy, echocardiography

Kaynakça

• 1. 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(11):1385-92. doi: 10.1016/j.hrthm.2007.06.024. PubMed PMID: 17954396.
• 2. Franklin WJ, Benton MK, Parekh DR. Cardiac disease in pregnancy. Texas Heart Institute journal 2011;38(2):151-3. PubMed PMID: 21494524; PubMed Central PMCID: PMC3066821.
• 3. O'Kelly AC, Sharma G, Vaught AJ, Zakaria S. The Use of Echocardiography and Advanced Cardiac Ultrasonography During Pregnancy. Curr Treat Options Cardiovasc Med. 2019 Nov 21;21(11):71. doi: 10.1007/s11936-019-0785-5. PMID: 31754837
• 4. Adamson DL, Nelson-Piercy C. Managing palpitations and arrhythmias during pregnancy. Heart 2007;93(12):1630-6. doi: 10.1136/hrt.2006.098822. PubMed PMID: 18003696; PubMed Central PMCID: PMC2095764.
• 5. Bouvier-Colle MH, Mohangoo AD, Gissler M, Novak-Antolic Z, Vutuc C, Szamotulska K, et al. What about the mothers? An analysis of maternal mortality and morbidity in perinatal health surveillance systems in Europe. BJOG : an international journal of obstetrics and gynaecology 2012;119(7):880-9; discussion 90. doi: 10.1111/j.1471-0528.2012.03330.x. PubMed PMID: 22571748; PubMed Central PMCID: PMC3472023.
• 6. Akdemir N1, Akarsu S, Türe S, Ozlem Akcinar V, et al. Evaluation of the relationship between heart type fatty acid binding protein levels and the risk of maternal cardiac ischemia in low risk obstetric population during delivery.Med Glas (Zenica). 2012 Aug;9(2):256-61. PMID: 22926360
• 7. Pietrasik G, Zareba W. QRS fragmentation: diagnostic and prognostic significance. Cardiology journal 2012;19(2):114-21. PubMed PMID: 22461043.
• 8. 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. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 2005;18(12):1440-63. doi: 10.1016/j.echo.2005.10.005. PubMed PMID: 16376782.
• 9. Soma-Pillay P, Nelson-Piercy C, Tolppanen H, Mebazaa A. Physiological changes in pregnancy. Cardiovascular journal of Africa 2016;27(2):89-94. doi: 10.5830/CVJA-2016-021. PubMed PMID: 27213856; PubMed Central PMCID: PMC4928162.
• 10. Cordina R, McGuire MA. Maternal cardiac arrhythmias during pregnancy and lactation. Obstetric medicine 2010;3(1):8-16. doi: 10.1258/om.2009.090021. PubMed PMID: 27582834; PubMed Central PMCID: PMC4989762.
• 11. Wenger NK, Hurst JW, Strozier VN. Electrocardiographic Changes in Pregnancy. The American journal of cardiology 1964;13:774-8. doi: 10.1016/0002-9149(64)90426-6. PubMed PMID: 14175532.
• 12. Ozmen N, Cebeci BS, Yiginer O, Muhcu M, Kardesoglu E, Dincturk M. P-wave dispersion is increased in pregnancy due to shortening of minimum duration of P: does this have clinical significance? The Journal of international medical research 2006;34(5):468-74. doi: 10.1177/147323000603400503. PubMed PMID: 17133775.
• 13. 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. doi: 10.1161/CIRCULATIONAHA.105.595892. PubMed PMID: 16717150.
• 14. Seong CS, Gwag HB, Hwang JK, Park SJ, Park KM, Kim JS, et al. Clinical significance of fragmented QRS complexes or J waves in patients with idiopathic ventricular arrhythmias. PloS one 2018;13(4):e0194363. doi: 10.1371/journal.pone.0194363. PubMed PMID: 29694354; PubMed Central PMCID: PMC5919047.
• 15. Shen L, Wu J, Xu G, Song L, Yang S, Yuan J, et al. Parity and Risk of Coronary Heart Disease in Middle-aged and Older Chinese Women. Scientific reports 2015;5:16834. doi: 10.1038/srep16834. PubMed PMID: 26607032; PubMed Central PMCID: PMC4660373.
• 16. Dhawan V, Brookes ZL, Kaufman S. Long-term effects of repeated pregnancies (multiparity) on blood pressure regulation. Cardiovascular research 2004;64(1):179-86. doi: 10.1016/j.cardiores.2004.06.018. PubMed PMID: 15364626.
• 17. Bernstein L, Pike MC, Ross RK, Judd HL, Brown JB, Henderson BE. Estrogen and sex hormone-binding globulin levels in nulliparous and parous women. Journal of the National Cancer Institute 1985;74(4):741-5. PubMed PMID: 3857369.
• 18. Skilton MR, Serusclat A, Begg LM, Moulin P, Bonnet F. Parity and carotid atherosclerosis in men and women: insights into the roles of childbearing and child-rearing. Stroke. 2009;40(4):1152-7. doi: 10.1161/STROKEAHA 108.535807. PubMed PMID: 19211493.
• 19. Vaidya D, Bennett WL, Sibley CT, Polak JF, Herrington DM, Ouyang P. Association of parity with carotid diameter and distensibility: multi-ethnic study of atherosclerosis. Hypertension 2014;64(2):253-8. doi: 10.1161/HYPERTENSIONAHA.114.03285. PubMed PMID: 24842921; PubMed Central PMCID: PMC4184976.
• 20. Oner E, Erturk M, Birant A, Kalkan AK, Uzun F, Avci Y, et al. Fragmented QRS complexes are associated with left ventricular systolic and diastolic dysfunctions in patients with metabolic syndrome. Cardiology journal 2015;22(6):691-8. doi: 10.5603/CJ.a2015.0045. PubMed PMID: 26202657.