Abstract 18098: Fragmented QRS as a Marker for Left Ventricular Remodeling

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Introduction: Fragmented QRS (fQRS) has been recognized as a predictor of cardiac prognosis in various cardiovascular diseases. It is thought that fQRS reflects conduction delay due to myocardial fibrosis or scar. Previous studies have demonstrated that patients with aortic stenosis (AS) exhibiting fQRS are associated with severe clinical phenotypes. However, correlations between fQRS and hemodynamics in severe AS patients have been unclear.

Hypothesis: We investigated (1) whether fQRS can be disappeared after aortic valve replacement (AVR) in AS patients, and (2) whether fQRS disappearance reflects left ventricular (LV) reverse remodeling after AVR.

Methods: The study subjects were consisted of consecutive 122 patients with AS who underwent isolated aortic valve surgery. Patients coexisting with coronary artery disease and mitral stenosis were excluded. E/E’ on echocardiography was used as a noninvasive marker for LV end-diastolic pressure. fQRS was defined as the presence of an additional R wave or notching in the nadir of the R wave or the S wave and presence in ≥2 continuous leads.

Results: fQRS was observed in 59 (48.4%) of the 122 patients (fQRS group). fQRS group had higher E/E’ (18.4±6.3 vs 13.6±5.0, p<0.001) and lower E’ (4.4±1.1 vs 5.7±2.1, p<0.001) compared to the non-fQRS group (n=63). No significant difference was observed as for left ventricular (LV) ejection fraction, LV end-diastolic dimension (LVEDd), plasma BNP levels between 2 groups before AVR. Of the 59 patients in the fQRS group, 23 (39%) showed disappearance of fQRS after AVR. Patients with fQRS disappearance exhibited smaller post-AVR LVEDd compared to those without fQRS disappearance (43.0 ± 5.6 vs. 46.6 ± 6.4, p=0.028).

Conclusions: These findings suggest that fQRS can be disappeared after AVR in AS patients. Furthermore, disappearance of fQRS may reflect LV reverse remodeling after AVR.

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