QRS micro-fragmentation as a mortality predictor

J 2022

QRS micro-fragmentation as a mortality predictor

HNATKOVA, Katerina, Irena ANDRŠOVÁ, Tomáš NOVOTNÝ, Annie BRITTON, Martin SHIPLEY et. al.

Basic information

Original name

QRS micro-fragmentation as a mortality predictor

Authors

HNATKOVA, Katerina (203 Czech Republic), Irena ANDRŠOVÁ (203 Czech Republic, belonging to the institution), Tomáš NOVOTNÝ (203 Czech Republic, belonging to the institution), Annie BRITTON, Martin SHIPLEY, Bert VANDENBERK, David J SPRENKELER, Juhani JUNTTILA, Tobias REICHLIN, Simon SCHLOEGL, Marc A VOS, Tim FRIEDE, Axel BAUER, Heikki V HUIKURI, Rik WILLEMS, Georg SCHMIDT, Michael R FRANZ, Christian STICHERLING, Markus ZABEL and Marek MALÍK (203 Czech Republic, guarantor, belonging to the institution)

Edition

European heart journal, Oxford, Oxford University Press, 2022, 0195-668X

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30201 Cardiac and Cardiovascular systems

Country of publisher

United Kingdom of Great Britain and Northern Ireland

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 39.300

RIV identification code

RIV/00216224:14110/22:00127066

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1093/eurheartj/ehac085

UT WoS

000758231400001

Keywords in English

Electrocardiogram; QRS complex; Fragmentation; Mortality prediction

Abstract

V originále

Aims Fragmented QRS complex with visible notching on standard 12-lead electrocardiogram (ECG) is understood to represent depolarization abnormalities and to signify risk of cardiac events. Depolarization abnormalities with similar prognostic implications likely exist beyond visual recognition but no technology is presently suitable for quantification of such invisible ECG abnormalities. We present such a technology. Methods and results A signal processing method projects all ECG leads of the QRS complex into optimized three perpendicular dimensions, reconstructs the ECG back from this three-dimensional projection, and quantifies the difference (QRS 'micro'-fragmentation, QRS-mu f) between the original and reconstructed signals. QRS 'micro'-fragmentation was assessed in three different populations: cardiac patients with automatic implantable cardioverter-defibrillators, cardiac patients with severe abnormalities, and general public. The predictive value of QRS-mu f for mortality was investigated both univariably and in multivariable comparisons with other risk factors including visible QRS 'macro'-fragmentation, QRS-Mf. The analysis was made in a total of 7779 subjects of whom 504 have not survived the first 5 years of follow-up. In all three populations, QRS-mu f was strongly predictive of survival (P < 0.001 univariably, and P < 0.001 to P = 0.024 in multivariable regression analyses). A similar strong association with outcome was found when dichotomizing QRS-mu f prospectively at 3.5%. When QRS-mu f was used in multivariable analyses, QRS-Mf and QRS duration lost their predictive value. Conclusion In three populations with different clinical characteristics, QRS-mu f was a powerful mortality risk factor independent of several previously established risk indices. Electrophysiologic abnormalities that contribute to increased QRS-mu f values are likely responsible for the predictive power of visible QRS-Mf. Key question The cardiac risk associated with visually diagnosed QRS fragmentation suggests that important QRS abnormalities might exist below the resolution of visual detection. Nevertheless, at present, little possibility exists to detect 'invisible' abnormalities of myocardial depolarization. Key finding QRS 'micro-fragmentation', QRS- analysis quantifies 'invisible' abnormalities of myocardial depolarization. It was found to independently predict death in three different populations of a total of 7779 subjects of whom 504 have not survived the first 5 years of follow-up. Take-home message QRS-mu f is a strong predictor of worsened survival. It can be assessed in standard short-term 12-lead electrocardiograms.

Citovat

HNATKOVA, Katerina, Irena ANDRŠOVÁ, Tomáš NOVOTNÝ, Annie BRITTON, Martin SHIPLEY, Bert VANDENBERK, David J SPRENKELER, Juhani JUNTTILA, Tobias REICHLIN, Simon SCHLOEGL, Marc A VOS, Tim FRIEDE, Axel BAUER, Heikki V HUIKURI, Rik WILLEMS, Georg SCHMIDT, Michael R FRANZ, Christian STICHERLING, Markus ZABEL and Marek MALÍK. QRS micro-fragmentation as a mortality predictor. European heart journal. Oxford: Oxford University Press, 2022, vol. 43, No 40, p. 4177-4191. ISSN 0195-668X. Available from: https://dx.doi.org/10.1093/eurheartj/ehac085.

@article{2228644,
   author = {Hnatkova, Katerina and Andršová, Irena and Novotný, Tomáš and Britton, Annie and Shipley, Martin and Vandenberk, Bert and Sprenkeler, David J and Junttila, Juhani and Reichlin, Tobias and Schloegl, Simon and Vos, Marc A and Friede, Tim and Bauer, Axel and Huikuri, Heikki V and Willems, Rik and Schmidt, Georg and Franz, Michael R and Sticherling, Christian and Zabel, Markus and Malík, Marek},
   article_location = {Oxford},
   article_number = {40},
   doi = {http://dx.doi.org/10.1093/eurheartj/ehac085},
   keywords = {Electrocardiogram; QRS complex; Fragmentation; Mortality prediction},
   language = {eng},
   issn = {0195-668X},
   journal = {European heart journal},
   title = {QRS micro-fragmentation as a mortality predictor},
   url = {https://academic.oup.com/eurheartj/article/43/40/4177/6533247},
   volume = {43},
   year = {2022}
}

TY  - JOUR
ID  - 2228644
AU  - Hnatkova, Katerina - Andršová, Irena - Novotný, Tomáš - Britton, Annie - Shipley, Martin - Vandenberk, Bert - Sprenkeler, David J - Junttila, Juhani - Reichlin, Tobias - Schloegl, Simon - Vos, Marc A - Friede, Tim - Bauer, Axel - Huikuri, Heikki V - Willems, Rik - Schmidt, Georg - Franz, Michael R - Sticherling, Christian - Zabel, Markus - Malík, Marek
PY  - 2022
TI  - QRS micro-fragmentation as a mortality predictor
JF  - European heart journal
VL  - 43
IS  - 40
SP  - 4177-4191
EP  - 4177-4191
PB  - Oxford University Press
SN  - 0195668X
KW  - Electrocardiogram
KW  - QRS complex
KW  - Fragmentation
KW  - Mortality prediction
UR  - https://academic.oup.com/eurheartj/article/43/40/4177/6533247
N2  - Aims Fragmented QRS complex with visible notching on standard 12-lead electrocardiogram (ECG) is understood to represent depolarization abnormalities and to signify risk of cardiac events. Depolarization abnormalities with similar prognostic implications likely exist beyond visual recognition but no technology is presently suitable for quantification of such invisible ECG abnormalities. We present such a technology. Methods and results A signal processing method projects all ECG leads of the QRS complex into optimized three perpendicular dimensions, reconstructs the ECG back from this three-dimensional projection, and quantifies the difference (QRS 'micro'-fragmentation, QRS-mu f) between the original and reconstructed signals. QRS 'micro'-fragmentation was assessed in three different populations: cardiac patients with automatic implantable cardioverter-defibrillators, cardiac patients with severe abnormalities, and general public. The predictive value of QRS-mu f for mortality was investigated both univariably and in multivariable comparisons with other risk factors including visible QRS 'macro'-fragmentation, QRS-Mf. The analysis was made in a total of 7779 subjects of whom 504 have not survived the first 5 years of follow-up. In all three populations, QRS-mu f was strongly predictive of survival (P < 0.001 univariably, and P < 0.001 to P = 0.024 in multivariable regression analyses). A similar strong association with outcome was found when dichotomizing QRS-mu f prospectively at 3.5%. When QRS-mu f was used in multivariable analyses, QRS-Mf and QRS duration lost their predictive value. Conclusion In three populations with different clinical characteristics, QRS-mu f was a powerful mortality risk factor independent of several previously established risk indices. Electrophysiologic abnormalities that contribute to increased QRS-mu f values are likely responsible for the predictive power of visible QRS-Mf. Key question The cardiac risk associated with visually diagnosed QRS fragmentation suggests that important QRS abnormalities might exist below the resolution of visual detection. Nevertheless, at present, little possibility exists to detect 'invisible' abnormalities of myocardial depolarization. Key finding QRS 'micro-fragmentation', QRS- analysis quantifies 'invisible' abnormalities of myocardial depolarization. It was found to independently predict death in three different populations of a total of 7779 subjects of whom 504 have not survived the first 5 years of follow-up. Take-home message QRS-mu f is a strong predictor of worsened survival. It can be assessed in standard short-term 12-lead electrocardiograms.
ER  -

HNATKOVA, Katerina, Irena ANDRŠOVÁ, Tomáš NOVOTNÝ, Annie BRITTON, Martin SHIPLEY, Bert VANDENBERK, David J SPRENKELER, Juhani JUNTTILA, Tobias REICHLIN, Simon SCHLOEGL, Marc A VOS, Tim FRIEDE, Axel BAUER, Heikki V HUIKURI, Rik WILLEMS, Georg SCHMIDT, Michael R FRANZ, Christian STICHERLING, Markus ZABEL and Marek MALÍK. QRS micro-fragmentation as a mortality predictor. \textit{European heart journal}. Oxford: Oxford University Press, 2022, vol.~43, No~40, p.~4177-4191. ISSN~0195-668X. Available from: https://dx.doi.org/10.1093/eurheartj/ehac085.

Detailed Information on Publication Record