Relationship between fragmented QRS and rheumatic mitral stenosis

Reliable new indice revealing subclinical myocardial injury that would establish the severity of rheumatic valve disease, guide therapeutic approach, and predict high risk of complication of rheumatic valve disease would be highly beneficial. Recently, the presence of fragmented QRS (fQRS) in ECG is accepted as a marker of subclinical myocardial fibrosis. The electrocardiographic demonstration of fQRS and its role as diagnostic indicator of the severity of mitral stenosis has not been described previously. The purpose of our study is to establish the frequency of fQRS in isolated rheumatic mitral stenosis compared with control groupWe prospectively studied 193 consecutive patients with echocardiography documented mitral stenosis and age/gender matched 97 healthy subject with normal echocardiography. Patients were categorized according to their NYHA functional class. Echocardiographic measurement of severity of mitral stenosis, ejection fraction, and pulmonary artery pressure were performed. The fQRS was defined on the routine 12-lead ECG and includes various morphologies of the QRS morphology with different RSR? patternsStatisticallly positive correlation were present between significant fQRS and mean mitral valve gradient (R=0.1, p=0.04). Statistically strong negative correlation were present between mitral valve area and presence of significant fQRS (R=-0.1, p=0.009). Presence of low ejection fraction, pulmonary hypertension and poor functional NYHA class were associated with high incidence of significant fQRS (R=0.1, p=0.02; R=0.1, p=0.001; R=0.1, p=0.01, respectively). Subgroup analysis in view of the presence atrial fibrillation in patient group revealed that there was relatively close relationship between significant fQRS and atrial fibrillation (p=0.06In conclusion, this is the first report showing that significant fQRS is related with 1) Echocardiographically severe mitral stenosis; 2) subclinical low ejection fraction; 3) Inreased pulmonary artery pressure; 4) Poor functional NYHA class. In our view, significant fQRS might be considered as novel indicator of echocardiographic severity and associated complication during follow-up of mitral stenosis. These interrelation need to be clarified in further study.