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Title: Baseline fragmented QRS is associated with increased all-cause mortality in heart failure with reduced ejection fraction: A systematic review and meta-analysis
Authors: Chanavuth Kanitsoraphan
Pattara Rattanawong
Poemlarp Mekraksakit
Pakawat Chongsathidkiet
Tanawan Riangwiwat
Napatt Kanjanahattakij
Wasawat Vutthikraivit
Saranapoom Klomjit
Subhanudh Thavaraputta
Duke University Medical Center
Texas Tech University Health Sciences Center at Lubbock
Faculty of Medicine, Ramathibodi Hospital, Mahidol University
University of Hawaii at Manoa
Faculty of Medicine, Siriraj Hospital, Mahidol University
Phramongkutklao College of Medicine
Einstein Medical Center
Keywords: Medicine
Issue Date: 1-Mar-2019
Citation: Annals of Noninvasive Electrocardiology. Vol.24, No.2 (2019)
Abstract: © 2018 Wiley Periodicals, Inc. Background: Recent studies suggested that fragmented (fQRS) is associated with poor clinical outcomes in heart failure with reduced ejection fraction (HFrEF) patients. However, no systematic review or meta-analysis has been done. We conducted a systematic review and meta-analysis to assess the association between baseline fQRS and all-cause mortality in HFrEF. Methods: We comprehensively reviewed the databases of MEDLINE and EMBASE from inception to February 2018. Published studies of HFrEF that reported fQRS and outcome of all-cause mortality and major arrhythmic event (sudden cardiac death, sudden cardiac arrest, ventricular fibrillation, or sustained ventricular tachycardia) were included. Data were integrated using the random-effects, generic inverse-variance method of DerSimonian and Laird. Results: Ten studies from 2010 to 2017 were included. Baseline fQRS was associated with increased all-cause mortality (risk ratio [RR] 1.63, 95% confidence interval [CI] 1.22–2.19, p < 0.0001, I 2  = 73%) as well as major arrhythmic events (RR = 1.74, 95% CI 1.09–2.80, I 2  = 89%). Baseline fQRS increased all-cause mortality in both Asian and Caucasian cohorts (RR = 2.17 with 95% CI 1.33–3.55 and RR = 1.45 with 95% CI 1.05–1.99, respectively) as well as increased major arrhythmic events in Asian cohort (RR = 1.50, 95% CI 1.05–2.13). Baseline fQRS also increased all-cause mortality in patients who had not received implantable cardioverter-defibrillator, significantly more than in patients who had received implantable cardioverter-defibrillator (RR = 2.46 with 95% CI 1.56–3.89 and 1.36 with 95% CI 1.08–1.71, respectively). Conclusion: Baseline fQRS is associated with increased all-cause mortality up to 1.63-fold in HFrEF patients. Fragmented QRS could be a predictor of clinical outcome in patients with HFrEF.
ISSN: 1542474X
Appears in Collections:Scopus 2019

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