A total of 140 patients with AMI were enrolled. Accoridng to the presence of fQRS in presenting electrocardiogram. The patients were divided into fQRS group and NonfQRS group. Real-time three-dimensional echocardiograph parameters measured in-hospital and 6-month follow-up period were collected.
Early Detection of Left Ventricular Dysfunction in Type II Diabetic Patients ...Premier Publishers
To assess Left ventricular (LV) systolic dysfunction using 2D speckle tracking echocardiography (STE) in asymptomatic type II Diabetic patients. We acquired three LV short-axis, and three LV apical views in 100 asymptomatic diabetic patients with normal LV ejection fraction (EF) and 25 age-matched healthy volunteers. We measured end-systolic longitudinal strain (LS), radial strain (RS), and circumferential strain (CS) in 18 LV segments. There were no significant differences in LVEF between two groups. Diabetic patients had more advanced diastolic dysfunction and increased LV mass compared with controlled group. Basal, middle, and apical LSs were significantly lower in diabetic patients compared with control subjects, with 43% (43/100) of the diabetic patients showing abnormal global LS values (cut-off value: 217.2 mean 2SD in control subjects Conclusion: Detecting subclinical LV systolic dysfunction by using 2D speckle tracking echocardiography (STE) might provide useful information of the risk stratification in an asymptomatic diabetic population.
Early Detection of Left Ventricular Dysfunction in Type II Diabetic Patients ...Premier Publishers
To assess Left ventricular (LV) systolic dysfunction using 2D speckle tracking echocardiography (STE) in asymptomatic type II Diabetic patients. We acquired three LV short-axis, and three LV apical views in 100 asymptomatic diabetic patients with normal LV ejection fraction (EF) and 25 age-matched healthy volunteers. We measured end-systolic longitudinal strain (LS), radial strain (RS), and circumferential strain (CS) in 18 LV segments. There were no significant differences in LVEF between two groups. Diabetic patients had more advanced diastolic dysfunction and increased LV mass compared with controlled group. Basal, middle, and apical LSs were significantly lower in diabetic patients compared with control subjects, with 43% (43/100) of the diabetic patients showing abnormal global LS values (cut-off value: 217.2 mean 2SD in control subjects Conclusion: Detecting subclinical LV systolic dysfunction by using 2D speckle tracking echocardiography (STE) might provide useful information of the risk stratification in an asymptomatic diabetic population.
The Association of Left Atrial Enlargement in Different Subtypes of Ischemic ...pateldrona
LAE related rhythm disturbance that characterize atrial fibrillation is also associated with other atrial derangement such as endothelial dysfunction and impaired myocyte function
The Association of Left Atrial Enlargement in Different Subtypes of Ischemic ...AnonIshanvi
LAE related rhythm disturbance that characterize atrial fibrillation is also associated with other atrial derangement such as endothelial dysfunction and impaired myocyte function. The role of LAE in acute cerebral infarction patient is not sufficiently described in literature.
The Association of Left Atrial Enlargement in Different Subtypes of Ischemic ...komalicarol
LAE related rhythm disturbance that characterize atrial fibrillation is
also associated with other atrial derangement such as endothelial dysfunction and impaired myocyte
function. The role of LAE in acute cerebral infarction patient is not sufficiently described in literature.
Hence of this study was undertaken to look for the frequency of left atrial enlargement in acute stroke
subtypes.
Coronary angioplasty has revolutionized the management of coronary artery disease. It has not ceased to develop to become the reference method of myocardial revascularization. The aim of our study is to evaluate the ultrasound parameters of left ventricular function after coronary angioplasty. This is a prospective analytical study including patients with stable coronary artery disease with a known coronary artery anatomy programmed for coronary angioplasty. Transthoracic echocardiography was performed four hours before and seven days after myocardial revascularization.
Correlation Between ECG Changes and 2D Speckle Tracking Echocardiography with...Premier Publishers
The clinical presentation of acute coronary syndrome is variable Patients with suspected NSTE-ACS are a heterogeneous group. Coronary occlusion may or may not be present. To correlate 2D speckle tracking echocardiography with coronary angiography results in non-ST segment elevation myocardial infarction patients and test its ability to predict culprit lesion. It is a prospective study where 100 patients with non-ST elevation myocardial infarction were enrolled in the study where regional wall motion score index was obtained by echocardiography then 2D speckle tracking echocardiography was done and territorial longitudinal strain for each vessel was obtained and finally coronary angiography was done. By using the bull’s eye view of the territorial LS values obtained from the 17 myocardial segments to predict the culprit artery for each patient the sensitivity for prediction of culprit LAD was 93.3 %, specificity was 92.7 %, For LCX; sensitivity was 82.7 %, specificity was 92.9 % and for RCA; sensitivity was 84 %, specificity was 93.3 %. Longitudinal strain imaging by 2D speckle-tracking might help in the work-up of non-ST elevation myocardial infarction patients. In addition, it may be helpful to localize coronary artery stenosis in a given perfusion territory.
The Indo-American Journal of Pharma and Bio Sciences is an online international journal that publishes articles quarterly.It's important to note that the specific policies, guidelines, and the editorial board of IAJPB may change over time, so it's advisable to visit the journal's official website or contact the journal of the materials science journal.
Speckle tracking echocardiography is a new, unique and evolving tool to assess the myocardial deformation which can detect LV systolic dysfunction much earlier than can be reflected in LVEF. The importance of defining predictors is to predict whom patient will be at risk for the deleterious effect of RV pacing on LV function, and who will need observation with possible upgrading to biventricular pacing.
Abstract
Objective: The objective of this study is to determine the normal value of 3D left ventricular (LV) twist in subendocardial, mid-wall and subepicardial layers, as well as to study the effects of aging on 3D LV twist by tagged MR motion tracking techniques. Three dimensional motion detection based on 3D tagged MR images is robust to out-of-plane motion error; while 2D motion detection is inherently unable to analyze the 3D cardiac motion and may lead to inaccurate results.
Methods: The 3D LV volumetric images were acquired in 52 normal adult subjects (aged 21-82) and were analyzed by using 3D HARmonic phase (HARP) technique. HARP technique provided the 3D displacement fields and the displacements were utilized to compute the rotational values. LV twist was defined as apical rotation relative to the basal rotation, in the 3D coordinates. The LV twist values of subendocardial, midwall and subepicardial layers were analyzed separately. The measured parameters in this study were: peak apical rotation, peak basal rotation, and peak LV twist.
Result: Looking at the apex, the normal LV maintains a clockwise rotation in the LV basal plane and a counterclockwise rotation in the LV apical plane. In general, the apical and basal rotation values increase during the aging process, leading to an increased value of LV twist. Peak epicardial LV twist is (10.4±2.6 degrees) which is lower than the mid-wall LV twist (11.3±2.2 degrees) and endocardial LV twist (12.1±2.6 degrees) in the young group (21-35 years old). Also, peak epicardial LV twist is (12.2±2.6 degrees) which is lower than the mid-wall LV twist (14.4±2.8 degrees) and endocardial LV twist (14.7±2.5 degrees) in the middle aged group (21-35 years old). In a similar way, peak epicardial LV twist is (14.8±2.9 degrees) which is lower than the mid-wall LV twist (15.7±3.6 degrees) and endocardial LV twist (16.7±3.0 degrees) in the old group (50-65 years old). Regarding the older group (more than 65 years old), peak epicardial LV twist is (15.9±3.1 degrees) which is lower than the mid-wall LV twist (16.2±3.4 degrees) and endocardial LV twist (18.3±3.0 degrees).
Conclusions: It is feasible to measure the subepicardial, mid-wall and subendocardial twist in tagged MR images. The twist value gradually increases in the aging process. Outside layers have greater twist values compared to the inside layers.
Cardiac Pacemakers: Function,
Troubleshooting, and Management
Part 1 of a 2-Part Series
Siva K. Mulpuru, MD, Malini Madhavan, MBBS, Christopher J. McLeod, MBCHB, PHD, Yong-Mei Cha, MD,
Paul A. Friedman, MD
Background: Arterial stiffness is an independent predictor of cardiovascular disease. Independent of aging and other cardiovascular risk factors, arterial stiffness increases from the proximal to the distal arterial compartments. The overall aim of this work is to establish a longitudinal mechanical mapping of the arterial tree in healthy individuals.
Methods: We report preliminary data quantifying stiffness of the abdominal aorta (AAA), common carotid artery (CCA) and brachial artery (BA) in adolescents. In group-1 subjects (from Melbourne, Australia), cine-loops of the AAA and CCA B-mode data were digitally recorded, whereas in group-2 (from Montreal, Canada), cine-loops of the CCA and BA B-mode data were acquired at the same clinical evaluation. Arterial wall elastic moduli (EIBM) were estimated off-line using our proprietary non-invasive imaging-based biomarker algorithm(ImBioMark).
Clinical Profile of Patients with Coronary Tortuosity and its Relation with C...Premier Publishers
Coronary tortuosity is a common angiographic finding. This study was done to observe the clinical profile of patients with coronary tortuosity (CT) and its relation with coronary artery disease (CAD). Method: A total 224 patients undergoing angiography for suspected CAD were included in the study. Coronary tortuosity was defined by the presence of ≥3 consecutive bends of > 45 degree, measured at end-diastole in an epicardial artery ≥2 mm in diameter. Coronary tortuosity was present in 45(20.1%) patients (CT group) in the study and another 45 patients without coronary tortuosity was randomly selected as control (NCT group). Clinical profile of CT and NCT group was compared. Results: Incidence of coronary tortuosity was significantly higher in females (p=0.000) and hypertensives (p=0.001) patients. Coronary tortuosity was most commonly seen in Left circumflex coronary artery. Incidence of CAD was significantly lower in CT group as compare to NCT group (0.02). Risk factors for CAD was associated with reduced incidence of Coronary tortuosity. Majority (88.5%) patient with CT without CAD presented with chronic stable angina out of which (65.2%) had an objective evidence of myocardial ischemia. Conclusion: Coronary tortuosity is more commonly seen females and hypertensive patients. It has negative correlation with CAD but can lead to myocardial ischemia. Risk factors of CAD do not predict CT.
Malignant Transformation in A Case of Multiple Osteochondromas: Role of FDG P...submissionclinmedima
We present a 19-year-old man affected by osteochondromatosis since he aged 9. Multiple enchondromas showed asymmetric distribution of osseous and cartilage lesions with major deformities of pelvis and long bones and minor lesions in left scapula and few ribs.
A 60 year old male was referred to a tertiary referral centre with a chronic dry cough. He was a lifelong non-smoker. Clinical examination was unremarkable. AssessmentIGE, RAST to common allergens, eosinophils and alpha one anti-trypsin were within normal limits. Barium swallow did not show any oesophageal dysmotility, gastric outlet obstruction or reflux
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Similar to Fragmented QRS Complex is associated with the Left Ventricular Remodeling in Patients with ST-Elevation Acute Myocardial In- farction
The Association of Left Atrial Enlargement in Different Subtypes of Ischemic ...pateldrona
LAE related rhythm disturbance that characterize atrial fibrillation is also associated with other atrial derangement such as endothelial dysfunction and impaired myocyte function
The Association of Left Atrial Enlargement in Different Subtypes of Ischemic ...AnonIshanvi
LAE related rhythm disturbance that characterize atrial fibrillation is also associated with other atrial derangement such as endothelial dysfunction and impaired myocyte function. The role of LAE in acute cerebral infarction patient is not sufficiently described in literature.
The Association of Left Atrial Enlargement in Different Subtypes of Ischemic ...komalicarol
LAE related rhythm disturbance that characterize atrial fibrillation is
also associated with other atrial derangement such as endothelial dysfunction and impaired myocyte
function. The role of LAE in acute cerebral infarction patient is not sufficiently described in literature.
Hence of this study was undertaken to look for the frequency of left atrial enlargement in acute stroke
subtypes.
Coronary angioplasty has revolutionized the management of coronary artery disease. It has not ceased to develop to become the reference method of myocardial revascularization. The aim of our study is to evaluate the ultrasound parameters of left ventricular function after coronary angioplasty. This is a prospective analytical study including patients with stable coronary artery disease with a known coronary artery anatomy programmed for coronary angioplasty. Transthoracic echocardiography was performed four hours before and seven days after myocardial revascularization.
Correlation Between ECG Changes and 2D Speckle Tracking Echocardiography with...Premier Publishers
The clinical presentation of acute coronary syndrome is variable Patients with suspected NSTE-ACS are a heterogeneous group. Coronary occlusion may or may not be present. To correlate 2D speckle tracking echocardiography with coronary angiography results in non-ST segment elevation myocardial infarction patients and test its ability to predict culprit lesion. It is a prospective study where 100 patients with non-ST elevation myocardial infarction were enrolled in the study where regional wall motion score index was obtained by echocardiography then 2D speckle tracking echocardiography was done and territorial longitudinal strain for each vessel was obtained and finally coronary angiography was done. By using the bull’s eye view of the territorial LS values obtained from the 17 myocardial segments to predict the culprit artery for each patient the sensitivity for prediction of culprit LAD was 93.3 %, specificity was 92.7 %, For LCX; sensitivity was 82.7 %, specificity was 92.9 % and for RCA; sensitivity was 84 %, specificity was 93.3 %. Longitudinal strain imaging by 2D speckle-tracking might help in the work-up of non-ST elevation myocardial infarction patients. In addition, it may be helpful to localize coronary artery stenosis in a given perfusion territory.
The Indo-American Journal of Pharma and Bio Sciences is an online international journal that publishes articles quarterly.It's important to note that the specific policies, guidelines, and the editorial board of IAJPB may change over time, so it's advisable to visit the journal's official website or contact the journal of the materials science journal.
Speckle tracking echocardiography is a new, unique and evolving tool to assess the myocardial deformation which can detect LV systolic dysfunction much earlier than can be reflected in LVEF. The importance of defining predictors is to predict whom patient will be at risk for the deleterious effect of RV pacing on LV function, and who will need observation with possible upgrading to biventricular pacing.
Abstract
Objective: The objective of this study is to determine the normal value of 3D left ventricular (LV) twist in subendocardial, mid-wall and subepicardial layers, as well as to study the effects of aging on 3D LV twist by tagged MR motion tracking techniques. Three dimensional motion detection based on 3D tagged MR images is robust to out-of-plane motion error; while 2D motion detection is inherently unable to analyze the 3D cardiac motion and may lead to inaccurate results.
Methods: The 3D LV volumetric images were acquired in 52 normal adult subjects (aged 21-82) and were analyzed by using 3D HARmonic phase (HARP) technique. HARP technique provided the 3D displacement fields and the displacements were utilized to compute the rotational values. LV twist was defined as apical rotation relative to the basal rotation, in the 3D coordinates. The LV twist values of subendocardial, midwall and subepicardial layers were analyzed separately. The measured parameters in this study were: peak apical rotation, peak basal rotation, and peak LV twist.
Result: Looking at the apex, the normal LV maintains a clockwise rotation in the LV basal plane and a counterclockwise rotation in the LV apical plane. In general, the apical and basal rotation values increase during the aging process, leading to an increased value of LV twist. Peak epicardial LV twist is (10.4±2.6 degrees) which is lower than the mid-wall LV twist (11.3±2.2 degrees) and endocardial LV twist (12.1±2.6 degrees) in the young group (21-35 years old). Also, peak epicardial LV twist is (12.2±2.6 degrees) which is lower than the mid-wall LV twist (14.4±2.8 degrees) and endocardial LV twist (14.7±2.5 degrees) in the middle aged group (21-35 years old). In a similar way, peak epicardial LV twist is (14.8±2.9 degrees) which is lower than the mid-wall LV twist (15.7±3.6 degrees) and endocardial LV twist (16.7±3.0 degrees) in the old group (50-65 years old). Regarding the older group (more than 65 years old), peak epicardial LV twist is (15.9±3.1 degrees) which is lower than the mid-wall LV twist (16.2±3.4 degrees) and endocardial LV twist (18.3±3.0 degrees).
Conclusions: It is feasible to measure the subepicardial, mid-wall and subendocardial twist in tagged MR images. The twist value gradually increases in the aging process. Outside layers have greater twist values compared to the inside layers.
Cardiac Pacemakers: Function,
Troubleshooting, and Management
Part 1 of a 2-Part Series
Siva K. Mulpuru, MD, Malini Madhavan, MBBS, Christopher J. McLeod, MBCHB, PHD, Yong-Mei Cha, MD,
Paul A. Friedman, MD
Background: Arterial stiffness is an independent predictor of cardiovascular disease. Independent of aging and other cardiovascular risk factors, arterial stiffness increases from the proximal to the distal arterial compartments. The overall aim of this work is to establish a longitudinal mechanical mapping of the arterial tree in healthy individuals.
Methods: We report preliminary data quantifying stiffness of the abdominal aorta (AAA), common carotid artery (CCA) and brachial artery (BA) in adolescents. In group-1 subjects (from Melbourne, Australia), cine-loops of the AAA and CCA B-mode data were digitally recorded, whereas in group-2 (from Montreal, Canada), cine-loops of the CCA and BA B-mode data were acquired at the same clinical evaluation. Arterial wall elastic moduli (EIBM) were estimated off-line using our proprietary non-invasive imaging-based biomarker algorithm(ImBioMark).
Clinical Profile of Patients with Coronary Tortuosity and its Relation with C...Premier Publishers
Coronary tortuosity is a common angiographic finding. This study was done to observe the clinical profile of patients with coronary tortuosity (CT) and its relation with coronary artery disease (CAD). Method: A total 224 patients undergoing angiography for suspected CAD were included in the study. Coronary tortuosity was defined by the presence of ≥3 consecutive bends of > 45 degree, measured at end-diastole in an epicardial artery ≥2 mm in diameter. Coronary tortuosity was present in 45(20.1%) patients (CT group) in the study and another 45 patients without coronary tortuosity was randomly selected as control (NCT group). Clinical profile of CT and NCT group was compared. Results: Incidence of coronary tortuosity was significantly higher in females (p=0.000) and hypertensives (p=0.001) patients. Coronary tortuosity was most commonly seen in Left circumflex coronary artery. Incidence of CAD was significantly lower in CT group as compare to NCT group (0.02). Risk factors for CAD was associated with reduced incidence of Coronary tortuosity. Majority (88.5%) patient with CT without CAD presented with chronic stable angina out of which (65.2%) had an objective evidence of myocardial ischemia. Conclusion: Coronary tortuosity is more commonly seen females and hypertensive patients. It has negative correlation with CAD but can lead to myocardial ischemia. Risk factors of CAD do not predict CT.
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Malignant Transformation in A Case of Multiple Osteochondromas: Role of FDG P...submissionclinmedima
We present a 19-year-old man affected by osteochondromatosis since he aged 9. Multiple enchondromas showed asymmetric distribution of osseous and cartilage lesions with major deformities of pelvis and long bones and minor lesions in left scapula and few ribs.
A 60 year old male was referred to a tertiary referral centre with a chronic dry cough. He was a lifelong non-smoker. Clinical examination was unremarkable. AssessmentIGE, RAST to common allergens, eosinophils and alpha one anti-trypsin were within normal limits. Barium swallow did not show any oesophageal dysmotility, gastric outlet obstruction or reflux
Food Allergy in School-Going Adolescents and Its Association with Depression ...submissionclinmedima
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
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MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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Fragmented QRS Complex is associated with the Left Ventricular Remodeling in Patients with ST-Elevation Acute Myocardial In- farction
1. Journal of Clinical and
MedicalImages
ISSN: 2640-9615
Research Article
FragmentedQRSComplexisassociatedwiththeLeftVentricular
Remodeling in Patients with ST-Elevation Acute Myocardial In-
farction
Yanmin Xu*
International Medical School, Tianjin Medical University, China
Volume 3 Issue 5- 2020
Received Date: 03 Feb 2020
Accepted Date: 02 Mar 2020
Published Date: 06 Mar 2020
2. Keywords
Acute myocardial infarction; Frag-
mented QRS; Three-dimensional
echocardiography; Left ventricular
remodeling
3. Introduction
1. Abstract
1.1. Objective: Toinvestigate the relationship between fQRS and the left ventricularremodel-
ing in patients with ST-elevation AMI in short-term and long-term period
1.2. Methods: A total of 140 patients with AMI were enrolled. Accoridng to the presence of
fQRS in presenting electrocardiogram. The patients were divided into fQRS group and Non-
fQRS group. Real-time three-dimensional echocardiograph parameters measured in-hospital
and 6-month follow-up period were collected. The difference between two groups and the
influencing factors of left ventricular remodeling were analyzed.
1.3. Results: LVESVwas significantly higher and LVEFwas significantlylower inshort-term
after PCI in fQRS group (P<0.01). There was no significant differences in LVEDV.Tmsv16-SD
(ms),Tmsv16-SD (%), Tmsv 16-Dif (ms) and Tmsv 16-Dif (%) in fQRS group were signifi-
cantly higher than those in Non-fQRS group (P<0.01). There were no significant differences
in Tmsv 12-SD (ms), Tmsv 12-SD (%), Tmsv 6-SD (ms), Tmsv 6-SD (%), Tmsv 12-Dif (ms),
Tmsv 12-Dif (%), Tmsv 6-Dif (ms) and Tmsv 6-Dif (%) between two groups. LVESV was sig-
nificantly higher LVEF was significantly lower in long-term after PCIin fQRS group (P<0.01).
There was no significant difference in LVEDV.Tmsv16-SD (%) and Tmsv 16-Dif (%) in fQRS
group were significantly higher than those in Non-fQRS group (P<0.05), but no significant
differences in Tmsv16-SD (ms), Tmsv 12-SD (ms), Tmsv 12-SD (%), Tmsv 6-SD (ms), Tmsv
6-SD (%), Tmsv 16-Dif (ms), Tmsv 12-Dif (ms), Tmsv 12-Dif (%), Tmsv 6-Dif (ms) and Tmsv
6-Dif (%) between two groups.
1.4. Conclusion: Left ventricular remodeling is more obvious in patients with AMI compli-
cated with fQRS in short-term and long-termperiod.
gated the association between fQRS and nosocomial and long-term
Acute myocardial infarction (AMI) is the disease with the highest
mortality among cardiovascular diseases [1].
Electrocardiogram
(ECG) plays a crucial role in the diagnosis and prognosis of acute
myocardial infarction. Currently, there are multiple ECG param-
eters available to assess the prognosis of patients with acute myo-
cardial infarction. Fragmented QRS (fQRS) is a new electrocardio-
graphic marker associated with abnormal conduction caused by
myocardial scarring or myocardial necrosis as well as conduction
delay peripheral to the infarct area [2]. A meta-analysis [3] investi-
cardiovascular events in patients with acute myocardial infarction.
The results showed no difference in the frequency of fQRS between
STEMI and NSTEMI patients. fQRS was associated with multives-
sel disease and low ejection fraction, and in addition, fQRS was
also associated with hospital mortality and long-term mortality
and MACE events. Myocardial remodeling is an important phase
of the development of acute myocardial infarction. It refers to the
process of changes in myocardial size, shape and tissue structure
resulting from myocardial injury or increased load, which may
*Corresponding Author (s): Yanmin Xu, International Medical School, Tianjin Medical Uni- Citation: Yanmin Xu, Fragmented QRS Complex is associated with the Left Ventricular Remodeling in
versity, No.22 Qi Xiang Tai Road, He Ping District, Tianjin 300070, P.R. China, E-mail: xuy-
anminphdmd@sina.com
Patients with ST-Elevation Acute Myocardial Infarction. Journal of Clinical and Medical Images. 2020;
V3(5): 1-8.
3. Volume 3 Issue 5 -2020 ResearchArticle
Clinandmedimages.com 3
captured during the end-diastolic and end-systolic phases were
selected among the images captured during consecutive cardiac
cycles, and two sampling points were selected on the left ventricu-
lar endocardial surface of the standard apical four-chamber view:
ventricular septum (S), and lateral wall (L); two sampling points
were selected on the left ventricular endocardial surface of the
standard apical two-chamber view: anterior wall (A) and inferior
wall (I). Then the cardiac apex of one of the aforementioned stan-
dard sections was chosen, the software would automatically out-
line three-dimensional endocardial contour for a frame-by-frame
sequence analysis. At the end of the sequence analysis, 17 volume
segments of the left ventricle, the left ventricular volume-time
curve (VTC) of 17 segments and the time-displacement bull’s eye
view were automatically obtained.
4.2.6 Predictors of Cardiac Ultrasonography: Overallsystol-
ic function of the heart: left ventricular end-diastolic volume
(LVEDV), left ventricular end-systolic volume (LVESV), left ven-
tricular ejection fraction (LVEF). Predictors of left ventricular sys-
tolic synchrony: the standard deviation of time to reach minimum
systolic volume for 16 left ventricular segments (Tmsv16-SD): 6
basal segments, 6 intermediate segments, and 4 apical segments;
the standard deviation of time to reach the minimum systolic
volume for the 12 left ventricular segments (Tmsv12-SD): 6 bas-
al segments, 6 intermediate segments; the standard deviation of
time to reach the minimum systolic volume for 6 left ventricular
segments (Tmsv6-SD): 6 basal segments; 6 basal segments; maxi-
mum difference of the time to reach the minimum systolic volume
for 16 left ventricular segments (Tmsv16-Dif): 6 basal segments,
6 intermediate segments and 4 apical segments; the maximum
difference of time to reach systolic volume for 12 left ventricular
segments (Tmsv12-Dif): 6 basal segments and 6 intermediate seg-
ments; the maximal difference of the time to reach minimum sys-
tolic volume for 6 left ventricular segments (Tmsv6-Dif): 6 basal
segments. In order to eliminate the influence of the heart rate in
patients, the Tmsv n-SD and Tmsv n-Dif predictors of the corre-
sponding myocardial segment were divided by the duration of one
cardiac cycle (RR interval) to obtain the corrected percentage indi-
cators: Tmsv16-SD%, Tmsv12-SD%, Tmsv6-SD%; Tmsv16-DIF%,
Tmsv12-DIF%, Tmsv6-DIF%.
4.2.7. Statistical Methods: A statistical analysis was performedus-
ing the SPSS 19.0 software package. The normally distributed mea-
surement data was expressed as mean±standard deviation and the
t-test was used for comparison between groups. The non-normally
distributed measurement data was expressed as median (P25, P75),
and the rank sum test was used for comparison between groups.
The count data was expressed as a percentage, and the chi-square
test was used for comparison between groups. Logistic regression
analysis was performed to investigate the factors affecting left ven-
tricular remodeling and cardiac function, and when p < 0.05, the
finding is considered statisticallysignificant.
4.3. Study Results
4.3.1ComparisonofBaseline Datain the TwoGroups: There
were no significant differences in clinical data such as age, gender,
smoking history, hypertension, diabetes, and D-to-B time between
the fQRS group and the Non-fQRS group. The intergroup differ-
ences in laboratory indicators such as CTnI, CK-MB, CK, TG, TC,
LDL-C, HDL-C, and Hs-CRP were not statistically significant. The
intergroup differences in the Gensini score for coronary angiogra-
phy results were not statistically significant (Table 1).
4.3.2. Comparisonof Short-Term Results of Three-Dimension-
al Echocardiography between Two Group: Overall functional
evaluation of the heart: the predictors of LVEDV, LVESV, LVEF
and so on were obtained by using the real-time three-dimension-
al echocardiography (RT-3D) to trace the endocardium and they
were indicative of the overall function of the heart. The non-fQRS
group had lower left ventricular end-systolic volume (LVESV) and
left ventricular ejection fraction (LVEF) than the non-fQRS group,
showing statistically significant differences (P<0.01), and the dif-
ference from the comparison in left ventricular end-diastolic vol-
ume (LVEDV) was not statistically significant (Table 2).
Evaluation of left ventricular systolic synchrony: the predictors of
left ventricular systolic synchrony were obtained by RT-3D tech-
nique, and the results showed that, the fQRS group had significant-
ly increased Tmsv 16-SD (ms), Tmsv 16-SD (%), Tmsv 16-Dif (ms)
and Tmsv 16-Dif (%) than the Non-fQRS group, showing statisti-
cally significant differences (P<0.01), and the differences from the
intergroup comparison in the remaining predictors were not statis-
tically significant: Tmsv 12-SD (ms), Tmsv 12-SD (%), Tmsv 6-SD
(ms), Tmsv 6-SD (%), Tmsv 12-Dif (ms), Tmsv 12-Dif (%), Tmsv
6-Dif (ms), and Tmsv 6-Dif (%) (Table3).
4.3.3. Comparison of Long-Term Results of Three-Dimension-
al Echocardiography between Two Group: Overall functional
evaluation of the heart: The fQRS group had lower left ventricular
end-systolic volume (LVESV) and left ventricular ejection fraction
(LVEF) than the non-fQRS group, showing statistically significant
differences (P<0.01), and the difference from the comparison in
left ventricular end-diastolic volume (LVEDV) was not statistically
4. Volume 3 Issue 5 -2020 ResearchArticle
Clinandmedimages.com 4
significant (Table 4).
Evaluation of left ventricular systolic synchrony: the fQRS group
had significantly increased Tmsv 16-SD (%) and Tmsv 16-Dif (ms)
than the Non-fQRS group, showing statistically significant differ-
ences (P<0.05), and the differences from the intergroup compari-
son in the remaining predictors were not statistically significant:
Tmsv 12-SD (ms), Tmsv 12-SD (%), Tmsv 6-SD (ms), Tmsv 6-SD
(%), Tmsv 16-Dif (ms), Tmsv 12-Dif (ms), Tmsv 12-Dif (%), Tmsv
6-Dif (ms) and Tmsv 6-Dif (%) (Table5).
Table 1: Comparison of baseline data between fQRS group and Non-fQRS group
fQRS group
(n+20)
N o n - f Q R S
group (n=20)
t p
Age(y) 60.9±10.363 7±7.40.984 .25
Hypertension(%) 8 13 2.51 .06
Diabetes mellitus (%) 4 4 0.00 .15
cTnI(ng/ml) 11.0± 3.8 7.0±23.1 1.18 .08
CK-MB(U/L) 96.2±70.462 3±42.6 1.85 .06
TC(mmol/L) 4.6±0.94 5±1.0 0.50 .15
TG(mmol/L) 1.8±0.81 7±0.9 1.70 .32
LDL-C(mmol/L) 3.0±0.72 8±0.7 0.70 .45
Hs-CRP(mg/L) 6.6=4.14 7=3.2 0.08 1.24
D to B(min) 46.6±29.553 4±28.1 0.07 1.22
Gensini score(point) 64.5±32.251 7±27.2 1.36 .08
Table2: Comparison of the short-term left ventricular systolic synchrony between
fQRS group and Non-fQRSgroup
fQRS group Non-fQRS group t p
Tmsv16-SDms) 82.0 ±47.725 0 1±9.04 .044**
0.001
Tmsv16-SD (%) 9.5 ±4.92 6 ±2.24 .408**
0.001
Tmsv12-SD(ms) 30.5 ±19.524 0 1±2.01 .031 0.68
Tmsv12-SD (%) 3.3± 1.9 2.4± 1.4 1.043 0.71
Tmsv6-SD(ms) 28.5± 14.216 0± 10.51 .319 0.42
Tmsv6-SD (%) 3.0 ±1.31 7± 1.21 .343 0.41
Tmsv16-Dif (ms) 335.0 ±176.798 0± 66.53 .887**
0.01
Tmsv16-Dif (%) 37.4 ±23.210 9± 8.04 .225**
0.01
Tmsv12-Dif(ms) 95.5± 64.780 0 ±41.51 .096 0.70
Tmsv12-Dif (%) 10.8 6±.4 8.04±.5 1.265 0.59
Tmsv6-Dif (ms) 75.0 ±40.546 0 ±29.51 .461 0.48
Tmsv6-Dif (%) 7.8 ±3.84 5 ±3.21 .408 0.46
Table 3: Comparison of short-term results of whole cardiac function from three-
dimensional between fQRS group and Non-fQRS group
QRS group (n=20)
N o n - f Q R S
group (n=20)
t/z p
LVEDV(ml) 103.3±29.4 90.1±20.7 1.662 0.86
LVESV (ml) 43.6±35.9 32.2 2±24.7 2.778**
0.05
LVEF (%) 51.4±6.7 58.5±5.0 -3.841**
0.05
Table4: Comparison of long-term results of whole cardiac function from three-di-
mensional between fQRS group and Non-fQRSgroup
Table 5: Comparison of the long-term left ventricular systolic synchrony between
fQRS group and Non-fQRSgroup
fQRS group (n=20) Non-fQRS?n=20) t p
Tmsv16-SD(ms) 46.5±20.524 0 ±17.01 .422 0.08
Tmsv16-SD(%) 4.8 ±2.4 2.5±2.31 .982**
0.01
Tmsv12-SD(ms) 18.5±10.0 21.0 ±10.00 .587 0.16
Tmsv12-SD(%) 1.9± 1.12 1±1.20 .496 0.15
Tmsv6-SD(ms) 18.0±8.2 15.0± 7.00 .418 0.14
Tmsv6-SD (%) 1.9 ±1.01 9±0.950 .026 1.36
Tmsv16-Dif (ms) 212.0±83.295 0±77.01 .343 0.08
Tmsv16-Dif(%) 23.9± 9.410 7±8.22 .034*
0.05
Tmsv12-Dif (ms) 65.0±29.570 0±31.50 .600 0.18
Tmsv12-Dif (%) 6.7± 3.66 8±3.70 .613 0.18
Tmsv6-Dif(ms) 45.5±21.03 7.02±4.5 .143 0.12
Tmsv6-Dif (%) 5.0 ±2.74 0±2.50 .365 0.36
4.3.4. Logistic Regression Analysis of Predictors for Left Ven-
tricular Remodeling: Thecut-offvalue wasobtainedbyapplying
the ROC curve, and Tmsv16-SD% was transformed into a binary
variable with 4.58% as the margin. A logistic regression analysis
was performed with Tmsv16-SD% as the dependent variable for
predictors of left ventricular remodeling (>4.58%=1, ≤4.58%=0)
and fQRS (positive=1, negative=0), age, Gensini score and so on as
independent variables. The results showed that, fQRS and age were
risk factors for left ventricularremodeling.
4.3.5. Analysis of Factors Influencing Cardiac Function: After
the clinical practice was taken into consideration, LVEF was trans-
formed into a binary variable with 50% as the margin. A logistic
regression analysis was performed with LVEF as the dependent
variable for predictors of cardiac function (>50%=0, ≤50%=1) and
fQRS (positive=1, negative=0), score and so on as independent
variables. The results showed that, fQRS were a risk factor for left
ventricular remodeling.
5. Discussion
The following theories have been proposed for the occurrence of
fQRS [4]: non-transmural myocardial scarring; conduction block
in infarct region; peri-infarction block; multifocal infarct; intracel-
lular impedance changes. In brief, fQRS is caused by the delayed or
continuity interruption of myocardial electrical activity resulting
from dyssynchrony in electrical activity of ventricular myocytes as
well as abnormal direction of excitation. Studies have shown that,
fQRS was associated with ventricular arrhythmias under various
conditions, such as ischemic/non-ischemic cardiomyopathy [5],
hypertrophic cardiomyopathy [6], Brugada syndrome, acquired
long QT syndrome [7] and arrhythmogenic right ventricular
dysplasia [8,9]. Tigen et al [10]., by examining 60 patients with
non-ischemic dilated cardiomyopathy, validated that thefragment-
fQRS group (n=20)
Non-fQRS group
(n=20)
t/z p
LVEDV(ml) 100.5±28.2 84.7±22.4 1.988 0.46
LVESV(ml) 39.9±34.6 26.8± 23.4 3.000**
0.01
LVEF(%) 56.0±6.3 62.4±5.6
-3.398
** 0.01
5. Volume 3 Issue 5 -2020 ResearchArticle
Clinandmedimages.com 5
ed QRS complex might be an effective predictor of the myocardial
systolic dyssynchrony in patients with dilated cardiomyopathy, and
claimed that, dilated cardiomyopathy patients with fragmented
QRS complex might benefit more from cardiac resynchronization
therapy (CRT). Basaran et al [11]. performed a cardiac magnetic
resonance imaging on 20 non-ischemic heart disease patients with
ECG-proved fragmented QRS complex to evaluate the association
between the fragmented QRS complex and the myocardial fibrosis
(expressed as delayed enhancement of strontium) and the frag-
mented QRS complex and the myocardial systolic dyssynchrony;
the results suggested that, the fQRS production was significantly
associated with intraventricular systolic dyssynchrony and myo-
cardial fibrosis in patients with non-ischemic dilated cardiomyop-
athy concurrently with narrow QRS interval and sinus rhythm. An
electrophysiological study suggested that, fQRS was a response to
ventricular fragmented potential and was the pathological basis for
arrhythmia. The study carried out by Ahmet Temiz et al [12]. indi-
cated that, fQRS was associated with the occurrence of paroxysmal
atrial fibrillation (PAF); the more fQRS leads were, the higher was
the likelihood of PAFoccurrence. Morita [13] et al. investigated the
incidence of fQRS in 115 patients with type I Brugada syndrome,
among which 43% had fQRS and other results included that, the
incidence of fQRS in the ventricular fibrillation group was higher
than the syncope group and the asymptomatic group, and the inci-
dence of ventricular fibrillation and syncope in the fQRS group was
58% while the incidence of ventricular fibrillation in the non-fQRS
group was only 6%. Therefore, the occurrence of fQRS in patients
with Brugada syndrome was predictive of a high risk for ventricu-
lar fibrillation and syncope.
In the present study, the association between fQRS and left ven-
tricular remodeling in patients with acute myocardial infarction
was investigated by the real-time three-dimensional color Doppler
ultrasound. The three-dimensional ultrasound technique was em-
ployed in the experiment to evaluate the short-term and long-term
results of cardiac systolic function after PCI, showing that, after
the hospital observation and the 6-month follow-up, the patients
in the fQRS group had larger left ventricular end-systolic volume
than the Non-fQRS group and had lower ejection fraction than
the Non-fQRS group, showing statistically significant differences,
and there was no significant difference from the comparison in left
ventricular end-diastolic volume; the comparison after 6-month
follow-up and hospital observation showed both the fQRS group
and the Non-fQRS group had elevated left ventricular ejection
fraction after 6-month follow-up, compared with during the hos-
pitalization period, showing statistically significant differences,
but the improvement in LVEDV and LVESV was not significant.
The acute myocardial infarction patients concomitantly with fQRS
had worse short-term and long-term systolic functions. Left ven-
tricular volume and systolic function could predict the outcome
of cardiovascular disease in many pathological [14-16]. Uslu et. al
[17]. revealed that, coronary heart disease patients with fQRS had
a lower LVEF, smaller left ventricular systolic and diastolic diame-
ters and a larger volume; Gungor et. al [3]. found that, among the
acute myocardial infarction patients, the fQRS positive group had
a lower LVEF than the fQRS negative group. We argued that, the
early concurrence of fQRS in acute myocardial infarction might
be indicative a greater infarct size, lower left ventricular systolic
function. Due to the interaction between left ventricular remod-
eling and cardiac function, left ventricular remodeling plays an
important role in the decline of cardiac systolic function. Follow-
ing the acute myocardial infarction was the harmful complication
characterized by the left ventricular enlargement [18,19], changes
in chamber geometry, and progressive deterioration of left ventric-
ular function. Ventricular remodeling had a direct association with
heart failure and poor prognosis [20,21]. Acute coronary syndrome
had a significant effect on left ventricular dyssynchrony, and acute
coronary syndrome has been shown to have a detrimental effect
on left ventricular systolic function [22]. In patients with impaired
left ventricular function, left ventricular dyssynchrony could pre-
dict left ventricular remodeling [23] and long-term prognosis [24].
Zhang et. al [25]. confirmed for the first time that, infarct size was
the main determinant of left ventricular dyssynchrony following
the acute myocardial infarction. Mollema et. al [26]. in their study
demonstrated that, left ventricular dyssynchrony in patients with
ST-segment elevation myocardial infarction might serve as an in-
dependent predictor for left ventricular remodeling at 6 months.
The present study showed that, the fQRS group had significantly
increased measurements in Tmsv 16-SD (ms), Tmsv 16-SD (%),
Tmsv 16-Dif (ms), and Tmsv 16-Dif (%) than the Non-fQRS group,
showing statistically significant differences, and the differences in
the remaining predictors were not statistically significant: Tmsv
12-SD (ms), Tmsv 12-SD (%), Tmsv 6-SD (ms), Tmsv 6-SD (%),
Tmsv 12-Dif The difference between (ms), Tmsv 12-Dif (%), Tmsv
6-Dif (ms), and Tmsv 6-Dif (%). After 6-month follow-up, during
which the effect of heart rate was eliminated, the fQRS group had
significantly increased measurements of Tmsv 16-SD (%) and
Tmsv 16-Dif (%) than the Non-fQRS group, the differences in the
remaining 12 segments and 6 segments were not statistically signif-
icant, indicating the fQRS group had a lower short-term and long-
term systolic synchrony of 16 left ventricular segments after PCI
6. Volume 3 Issue 5 -2020 ResearchArticle
Clinandmedimages.com 6
than the Non-fQRS group. Siva Sankara et. al [27]. investigated the
effect of left ventricular dyssynchrony on prognosis and the results
showed that, the left ventricular dyssynchrony was significantly el-
evated in patients with anterior myocardial infarction. The higher
the left ventricular dyssynchrony, the higher was the Killips grade.
Compared to the lesion located in the anterior descending branch
and the circumflex branch, the patients whose lesion happened to
be the right coronary artery had a relatively low left ventricular
asynchrony, but there was no significant difference between the pa-
tients with the lesion located at the anterior descending branch and
those at the circumflex artery. However, in the study performed by
Ng et al [23]., the left ventricular dyssynchrony was higher in pa-
tients with stenotic proximal circumflex branch, and there was no
significant difference between the patients with lesion at the ante-
rior descending and those at the right coronary artery. At present,
the relationship between the lesion site and the left ventricular sys-
tolic synchrony has not been established still, and further research
is needed by performing large-scale clinicaltrials.
In the present study, the short-term and long-term left ventricular
remodeling in the fQRS group and the Non-fQRS group was com-
pared. The results showed that, in the fQRS group the 16-segment
measurements were significantly smaller after six-month follow-up
than those during the hospitalization, while in the Non-fQRS
group there was no significant difference in the measurements of
left-ventricular systolic synchrony after the six-month follow-up,
compared with during the hospitalization. The comparisons indi-
cate that, the long-term left ventricular remodeling was significant-
ly improving in post-PCI patients with fQRS wave. Siva Sankara et.
al [27]. observed that, among the patients with acute myocardial
infarction who underwent PCI, those with high left ventricular
synchrony had increased left ventricular diameter, decreased ejec-
tion fraction, and severe diastolic dysfunction after 6-month fol-
low-up. The results of the present study showed that, in both fQRS
group and the Non-fQRS group, the left ventricular ejection frac-
tion increased from baseline after 6-month follow-up; the 16-seg-
ment systolic synchrony in the fQRS group was superior to base-
line; in the Non-fQRS group, there was no significant difference in
the left ventricular systole synchrony between at the baseline and
after 6-month follow-up, which was inconsistent with the findings
of Siva Sankara et. al. Left ventricular systolic dyssynchrony was
an important predictor of left ventricular remodeling [28]. A study
has confirmed that [29] acute myocardial infarction affected the
ventricular systolic synchrony, and the degree of left ventricular
systolic dyssynchrony had a close association with the size and the
transmurality of myocardial infarct, and the left ventricular systol-
ic dyssynchrony might serve as a predictor for left ventricular re-
modeling. In a logistic regression analysis, Tmsv16-SD% was used
as the dependent variable of left ventricular remodeling predictor.
The results showed that, fQRS and age had an effect on left ven-
tricular remodeling, with relatively large OR value of fQRS and the
95% CI of OR.
We further compared the volume-time curve (VTC) of the 17 seg-
ments in the fQRS group and in the Non-fQRS group. The vol-
ume-time curve of the fQRS group was more disordered in the
fORS group and in the non-fQRS group, and the difference of time
for each segment to reach the left ventricular end-systolic volume
was relatively large. The areas with an abnormal motion of the pa-
tients in the fQRS group had a larger range than those in the non-
fQRS group, and the patients in the fQRS had a worse left ventric-
ular systolic synchrony.
In summary, Left ventricular remodeling is more obvious in pa-
tients with acutemyocardial infarction complicated with fQRS in
short-term and long-term, and theheart function is worse in pa-
tients with fQRS. FQRS can predict left ventricular remodeling and
heart function .
References
1. Das MK, Khan B, Jacob S, KumarA, Mahenthiran J.Significance of a
fragmented QRS complex versus a Q wave in patients with coronary
artery disease. Circulation. 2006; 113(21): 2495–501.
2. Das MK1, Suradi H, Maskoun W, Michael MA, Shen C, Peng J, et
al. Fragmented wide QRS on a 12-lead ECG: A sign of myocardial
scar and poor prognosis. Circ Arrhythm Electrophysiol. 2008; 1(4):
258–268.
3. Gungor B, Ozcan KS, Karatas MB, Sahin I, Ozturk R, Bolca O. Prog-
nostic Value of QRS Fragmentation in Patients with Acute Myocar-
dial Infarction: A Meta-Analysis. Ann Noninvasive Electrocardiol.
2016; 21(6): 604-612.
4. Flowers NC, Horan LG, Thomas JR, Tolleson WJ. The anatomic basis
for high-frequency components in the electrocardiogram. Circula-
tion. 1969; 39(4): 531-539.
5. Lesh MD, Spear JF, Simson MB. A computer model of the electro-
gram: what causes fractionation?. J Electrocardiol, 1988; 21SupplS:
69-73.
6. Sha J, Zhang S, Tang M, Chen K, Zhao X, Wang F.Fragmented QRS
7. Volume 3 Issue 5 -2020 ResearchArticle
Clinandmedimages.com 7
is associated with all-cause mortality and ventricular arrhythmias in
patient with idiopathic dilated cardiomyopathy. Ann Noninvasive
Electrocardiol. 2011; 16(3): 270-275.
7. Femenia F, Arce M, Van Grieken J, Trucco E, Mont L, Abello M, et
al. Fragmented QRS as a predictor of arrhythmic events in patients
with hypertrophic obstructive cardiomyopathy. J Interv Card Elec-
trophysiol. 2013; 38(3):159-165.
8. Priori SG, Gasparini M, Napolitano C, Della Bella P, Ottonelli AG,
Sassone B, et al. Risk stratification in Brugada syndrome: results of
the PRELUDE (PRogrammed ELectrical stimUlation preDictive val-
uE) registry. J Am Coll Cardiol. 2012; 59(1): 37-45.
9. Haraoka K, Morita H, Saito Y,TohN, Miyoshi T,Nishii N, et al. Frag-
mented QRS is associated with torsades de pointes in patients with
acquired long QT syndrome. Heart Rhythm. 2010; 7(12): 1808-1814.
10. Tigen K, Karaahmet T, Gurel E, Cevik C, Nugent K, Pala S, et al.
The utility of fragmented QRS complexes to predict significant in-
traventricular dyssynchrony in nonischemic dilated cardiomyopathy
patients with a narrow QRS interval. Can J Cardiol. 2009; 25(9): 517-
522.
11. Basaran Y, Tigen K, Karaahmet T, Isiklar I, Cevik C, Gurel E, et al.
Fragmented QRS complexes are associated with cardiac fibrosis and
significant intraventricular systolic dyssynchrony in nonischemic di-
lated cardiomyopathy patients with a narrow QRS interval. Echocar-
diography. 2011; 28(1): 62-68.
12. Temiz A, Gazi E, Gungor O, Altun B, Barutcu A, Bekler A, et al.
Fragmented QRS and prediction of paroxysmal atrial fibrillation ep-
isodes. Pak J Med Sci. 2014; 30(4): 862-867.
13. Morita H, Kusano KF, Miura D, Nagase S, Nakamura K, Morita ST,
et al. Fragmented QRS as a marker of conduction abnormality and
a predictor of prognosis of Brugada syndrome. Circulation. 2008;
118(17): 1697-1704.
14. St John Sutton MG, Plappert T, Abraham WT, Smith AL, DeLurgio
DB, Leon AR, et al. Effect of cardiac resynchronization therapy on
left ventricular size and function in chronic heart failure. Circulation.
2003; 107(15): 1985-1990.
15. Kanzaki H. Mechanical dyssynchrony is not everything of substrate
but is essential for cardiac resynchronization therapy. Is assessment
of mechanical dyssynchrony necessary in determining CRT indica-
tion? (Pro). Circ J. 2011; 75(2): 457-464.
16. Davies MJ. The cardiomyopathies: an overview. Heart. 2000; 83(4):
469-474.
17. Uslu N, Gul M, Cakmak HA, Atam A, Pusuroglu H, Satilmisoglu H,
et al. The assessment of relationship between fragmented QRS com-
plex and left ventricular wall motion score index in patients with ST
elevation myocardial infarction who underwent primary percutane-
ous coronary intervention. Ann Noninvasive Electrocardiol. 2015;
20(2): 148-157.
18. Giannuzzi P,TemporelliPL, Bosimini E, Gentile F,Lucci D,Maggioni
AP, et al. Heterogeneity of left ventricular remodeling after acute
myocardial infarction: results of the Gruppo Italiano per lo Studio
della Sopravvivenza nell’Infarto Miocardico-3 Echo Substudy. Am
Heart J. 2001; 141(1):131-138.
19. White HD, Norris RM, Brown MA, Brandt PW, Whitlock RM, Wild
CJ, et al. Left ventricular end-systolic volume as the major determi-
nant of survival after recovery from myocardial infarction. Circula-
tion. 1987; 76(1): 44-51.
20. Multicenter Postinfarction Study Group. Risk stratification and sur-
vival after acute myocardial infarction. N Engl J Med. 1983; 309: 331-
336.
21. Volpi A, De Vita C, Franzosi MG, Geraci E, Maggioni AP, Mauri F,
et al. Determinants of 6-month mortality in survivors of myocardial
infarction after thrombolysis: results of the GISSI-2 database. Circu-
lation. 1993; 88: 416-426.
22. Nucifora G, Bertini M, Marsan NA, Delgado V, Scholte AJ, Ng AC,
et al. Impact of left ventricular dyssynchrony early on left ventricular
function after first acute myocardial infarction. Am J Cardiol. 2010;
105(3): 306-311.
23. Ng AC, Tran da T, Allman C, Vidaic J, Leung DY. Prognostic impli-
cations of left ventricular dyssynchrony early after non-ST elevation
myocardial infarction without congestive heart failure. Eur Heart J.
2010; 31(3): 298-308.
24. Shin SH, Hung CL, Uno H, Hassanein AH, Verma A, Bourgoun M, et
al. Mechanical dyssynchrony after myocardial infarction in patients
with left ventricular dysfunction, heart failure, or both. Circulation.
2010; 121(9): 1096-1103.
25. Zhang Y,Chan AK, Yu CM, Lam WW, Yip GW, Fung WH, et al. Left
ventricular systolic asynchrony after acute myocardial infarc- tion in
patientswithnarrowQRScomplexes.AmHeartJ.2005;149:497-503.
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26. Mollema SA, Liem SS, Suffoletto MS, Bleeker GB, van der Hoeven
BL, van de VeireNR,etal. Leftventricular dyssynchronyacutelyafter
myocardial infarction predicts left ventricular remodeling. J Am Coll
Cardiol. 2007; 50(16):1532-1540.
27. C. Siva Sankara, D. Rajasekhar, V. Vanajakshamma, B.S. Praveen
Kumar, A. Vamsidhara. Prognostic significance of NT-proBNP, 3D
LA volume and LV dyssynchrony in patients with acute STEMI un-
dergoing primary percutaneous intervention. Indian Heart J. 2015;
67(4): 318-327.
28. Jum Suk Ko, Myung Ho Jeong, Min Goo Lee, Shin Eun Lee, Won
Yu Kang, Soo Hyun Kim, et al. Left Ventricular Dyssynchrony After
Acute Myocardial Infarction is a Powerful Indicator of Left Ventric-
ular Remodeling. Korean Circ J. 2009; 39(6): 236-242.
29. Tanriverdi Z, Dursun H, Kaya D. The Importance of the Number
of Leads with fQRS for Predicting In-Hospital Mortality in Acute
STEMI Patients Treated with Primary PCI. Ann Noninvasive Elec-
trocardiol. 2016; 21(4): 413-419.