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Title: Fragmented QRS is associated with subclinical left ventricular dysfunction in patients with chronic kidney disease
Author(s): A. Adar , A. Kiriş , Ş. Ulusoy , G. Özkan , H. Bektaş , S. Okutucu , O. Onalan
Journal: Acta Cardiologica
Volume: 69    Issue: 4   Date: 2014   
Pages: 385-390
DOI: 10.2143/AC.69.4.3036654

Abstract :
Objective: We aimed to investigate the association of fragmented QRS (fQRS) with subclinical left ventricular (LV) dysfunction in patients with chronic kidney disease (CKD).
Methods and results: Patients with CKD who had a normal LV ejection fraction (≥ 50%) were enrolled. The tissue Doppler-derived Tei index was measured for all patients. A Tei index of ≥ 0.5 was considered abnormal. Subclinical LV dysfunction was defined as the presence of an abnormal Tei index in the absence of impaired LV ejection fraction (< 50%). The fQRS was defined as the presence of an additional R wave (R’) or notching of R or S wave or the presence of fragmentation in two contiguous ECG leads. The study group consisted of 82 patients (45 male, mean age 54 ± 14 years). Overall, prevalence of fQRS was 60% among CKD patients who had a preserved LV ejection fraction. Of these, 52 (63%) had an abnormal (≥ 0.5) and 30 (37%) a normal Tei index (< 0.5). The prevalence of fQRS was significantly higher in patients with an abnormal Tei index than in patients with a normal Tei index (71% vs. 40%, P = 0.006). Patients with an abnormal Tei index had a lower E/A ratio as compared to patients with a normal Tei index (P = 0.03). Groups were similar with respect to all other variables. In multivariate logistic regression analysis, the presence of fQRS was independently associated (OR 3.52, 95% CI 1.28-9.64) with the presence of an abnormal Tei index after adjustment for potential confounders.
Conclusion Fragmented QRS is independently associated with subclinical LV dysfunction in patients with CKD and normal ejection fraction.

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