Role of QRS Fragmentation for Risk Stratification in Adults With Tetralogy of Fallot

Autor: Malini Madhavan, Srikanth Kothapalli, Naser M. Ammash, Mohamed Farouk Abdelsamid, Heidi M. Connolly, Alexander C. Egbe, William R. Miranda, Abhishek Deshmukh, Nandini Mehra, Venkata R. Missula
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Adult
Male
medicine.medical_specialty
QRS fragmentation
Time Factors
Databases
Factual
electrocardiography
Action Potentials
risk stratification
030204 cardiovascular system & hematology
Qrs fragmentation
Risk Assessment
03 medical and health sciences
Young Adult
0302 clinical medicine
Heart Conduction System
Heart Rate
Predictive Value of Tests
Risk Factors
Internal medicine
Cause of Death
medicine
Humans
030212 general & internal medicine
cardiovascular diseases
tetralogy of Fallot
Tetralogy of Fallot
Original Research
Retrospective Studies
medicine.diagnostic_test
business.industry
Congenital Heart Disease
Arrhythmias
Cardiac
Middle Aged
medicine.disease
Prognosis
mortality
3. Good health
Risk stratification
Cardiology
cardiovascular system
Female
Cardiology and Cardiovascular Medicine
business
Electrocardiography
Zdroj: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
ISSN: 2047-9980
Popis: Background Patients with tetralogy of Fallot ( TOF ) remain at risk for cardiovascular events despite successful repair. Some of the current risk stratification tools require advanced imaging and invasive studies, and hence are difficult to apply to routine patient care. A recent study showed that QRS fragmentation ( QRS ‐f) is predictive of mortality in patients with TOF. The current study aims to validate this result by assessing whether severity of QRS ‐f could predict all‐cause mortality in a different TOF population. Methods and Results The authors reviewed the Mayo Adult Congenital Heart Disease database for patients with TOF who had ECG from 1990–2017. QRS ‐f was defined as notches in QRS complex in ≥2 contiguous leads on ECG , not related to bundle branch block, and classified as none, mild (≤3 leads), moderate (4 leads), or severe (≥5 leads). Of 465 patients (age 37±14 years) in the study, QRS ‐f was present in 161 (35%): mild (n=43, 9%), moderate (n=77, 17%), and severe (n=41, 9%). There were 55 deaths (12%) during 13.6±8.2 years of follow‐up. Severity of QRS ‐f remained an independent predictor of all‐cause mortality after adjustment for other ECG parameters, patient demographics, and atrial and ventricular arrhythmia (hazard ratio, 1.74 per class; 95% confidence interval, 1.08–2.93 [ P =0.041]). Conclusions The presence of severe QRS ‐f may be used as complementary data to the usual clinical indices to determine whether interventions such as invasive electrophysiology study should be performed in patients with nonsustained ventricular tachycardia or to proceed with pulmonary valve replacement in patients with severe pulmonary regurgitation with ventricular volumes below the guideline‐directed threshold for intervention.
Databáze: OpenAIRE
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