Fragmented QRS complex is an independent predictor of plaque burden in patients at intermediate risk of coronary artery disease.

OBJECTIVE: We aimed to evaluate the relationship between fragmented QRS complex and plaque burden in patients presented with typical chest pain and deemed to have intermediate pretest probability of CAD using coronary computed tomography angiography (CCTA). METHODS: We studied electrocardiograms (ECGs) obtained from 172 subjects (47.5 ± 9.5 years, 125 were men) presented with chest pain and had intermediate pretest probability for CAD. The presence was found and evaluation of CAD was performed with CCTA. RESULTS: Seventy four (43%) of the study cohort had CCTA-documented CAD. Meanwhile the frequency of fQRS in our cohort was (57%). 70 (71.4%) patients with fQRS had CAD compared with only 4 (5.4%) patients without fQRS (p < 0.001). The number of leads with fQRs was correlated with the calcium score (p < 0.005), segment stenosis score, segment involvement score, total plaque score (TPS), and E/e ratio (p < 0.001, for all). Multivariate analysis demonstrated that fQRS was a strong independent predictor for CAD (or = 2.15, p < 0.001). ROC analysis showed that the number of leads ≥3 was the optimal number for predicting CAD (AUC = 0.89, sensitivity 88%, and specificity 83%, p < 0.001). CONCLUSION: Fragmented QRS was seen more often in patients with high plaque burden. We suggest that fQRS might provide a useful noninvasive prognosticator for subjects with intermediate pretest probability of CAD for further investigation.

Usefulness of the Global Echo-Doppler Score (GEDS) in selection of patients with mitral stenosis for percutaneous balloon mitral valvuloplasty.

BACKGROUND: We aimed to create a novel modified score by combining anatomic and hemodynamic Doppler-echocardiographic measures for selection of suitable patients with mitral stenosis for percutaneous balloon mitral valvuloplasty (PBMV) and its impact in prediction of outcome. METHODS: 262 consecutive patients candidate for PBMV were enrolled. Wilkins score and a global score based on anatomical parameters (Wilkins score, posterior to anterior mitral leaflet ratio [PMVL/AMVL ratio]; left atrial diameter [LAD]) and hemodynamic parameters (mitral regurgitation [MR]; atrioventricular compliance [CN]; systolic pulmonary artery pressure [SPAP]) were assessed. Patients were classified into two groups according to their outcomes. RESULTS: Global Echo-Doppler Score (GEDS) for patients with favorable vs. those with unfavorable outcomes was (5.0 ± 0.9 vs. 8.9 ± 1.3; p < 0.001). Sensitivity, specificity, and accuracy of a GEDS ≥ 7 for prediction of cardiac events were 97.5%, 88%, and 97.5%, respectively. The area under the receiver operating characteristic curve was 0.95 (p < 0.001). The correlation coefficient was 0.852 (p < 0.0001) for GEDS 0.531 (p < 0.002), for Wilkins score 0.315 (p < 0.02), for PMVL/AMVL 0.460 (p < 0.01), for LAD; MR: Pre-PBMV (r = 0.348, p < 0.03); CN [mL/mm Hg] (r = 0.579, p < 0.01) and SPAP [mm Hg] (r = 0.499, p < 0.01). In the regression analysis, GEDS, Wilkins score, and LAD were entered into the model. The regression coefficient (r = 0.695) of GEDS was much higher than those of the other 2 factors. CONCLUSIONS: GEDS is an independent predictor of PBMV success and clinical outcome and may be formulated in a scoring system that would help to identify the proper timing and best candidates for PBMV.