Significance of a fragmented QRS complex versus a Q wave in patients with coronary artery disease.


BACKGROUND:Q waves on a 12-lead ECG are markers of a prior myocardial infarction (MI). However, they may regress or even disappear over time, and there is no specific ECG sign of a non-Q-wave MI. Fragmented QRS complexes (fQRSs), which include various RSR' patterns, without a typical bundle-branch block are markers of altered ventricular depolarization owing to a prior myocardial scar. We postulated that the presence of an fQRS might improve the ability to detect a prior MI compared with Q waves alone by ECG. METHODS AND RESULTS:A cohort of 479 consecutive patients (mean+/-SD age, 58.2+/-13.2 years; 283 males) who were referred for nuclear stress tests was studied. The fQRS included various morphologies of the QRS (<120 ms), which included an additional R wave (R') or notching in the nadir of the S wave, or >1 R' (fragmentation) in 2 contiguous leads, corresponding to a major coronary artery territory. The Q wave was present in 71 (14.8%) patients, an fQRS was present in 191 (34.9%) patients, and an fQRS and/or a Q wave was present in 203 (42.3%) patients. Sensitivity, specificity, and the negative predictive value for myocardial scar as detected by single photon emission computed tomography analysis were 36.3%, 99.2%, and 70.8%, respectively, for the Q wave alone; 85.6%, 89%, and 92.7%, respectively, for the fQRS; and 91.4%, 89%, and 94.2%, respectively, for the Q wave and/or fQRS. CONCLUSIONS:The fQRS on a 12-lead ECG is a marker of a prior MI, defined by regional perfusion abnormalities, which has a substantially higher sensitivity and negative predictive value compared with the Q wave.






Das MK,Khan B,Jacob S,Kumar A,Mahenthiran J




Has Abstract


2006-05-30 00:00:00














  • Vein graft stenosis and the heparin responsiveness of human vascular smooth muscle cells.

    abstract:BACKGROUND:Vascular smooth muscle cell (VMSC) proliferation is an essential component of myointimal hyperplasia, which is implicated in the failure of 30% to 50% of vascular interventions, such as coronary angioplasty and peripheral vein grafting. We have shown that cells derived from stenotic lesions in infrainguinal ...


    pub_type: 杂志文章


    authors: Refson JS,Schachter M,Patel MK,Hughes AD,Munro E,Chan P,Wolfe JH,Sever PS

    更新日期:1998-06-30 00:00:00

  • Myofilament calcium regulation in human myocardium.

    abstract:BACKGROUND:We investigated whether decreased myofilament calcium contractile activation may, in part, contribute to heart failure. METHODS AND RESULTS:Calcium concentration required for 50% activation and Hill coefficient for fibers from nonfailing and failing human hearts at pH 7.1 were not different. Maximum calcium...


    pub_type: 杂志文章


    authors: Hajjar RJ,Schwinger RH,Schmidt U,Kim CS,Lebeche D,Doye AA,Gwathmey JK

    更新日期:2000-04-11 00:00:00

  • Polyethylene glycol-derivatized cysteine-substitution variants of recombinant staphylokinase for single-bolus treatment of acute myocardial infarction.

    abstract:BACKGROUND:Thrombolytic therapy of acute myocardial infarction (AMI) is evolving toward bolus administration. Derivatization of proteins with polyethylene glycol (PEG) may reduce their clearance. METHODS AND RESULTS:A staphylokinase (SakSTAR) variant with 12 amino acid substitutions to reduce its antigenicity, SakSTAR...


    pub_type: 临床试验,杂志文章


    authors: Collen D,Sinnaeve P,Demarsin E,Moreau H,De Maeyer M,Jespers L,Laroche Y,Van de Werf F

    更新日期:2000-10-10 00:00:00

  • Real-time three-dimensional echocardiography: a novel technique to quantify global left ventricular mechanical dyssynchrony.

    abstract:BACKGROUND:Left ventricular (LV) mechanical dyssynchrony (LVMD) has emerged as a therapeutic target using cardiac resynchronization therapy (CRT) in selected patients with chronic heart failure. Current methods used to evaluate LVMD are technically difficult and do not assess LVMD of the whole LV simultaneously. We dev...


    pub_type: 杂志文章


    authors: Kapetanakis S,Kearney MT,Siva A,Gall N,Cooklin M,Monaghan MJ

    更新日期:2005-08-16 00:00:00

  • A1-adenosine receptor inhibition of adenylate cyclase in failing and nonfailing human ventricular myocardium.

    abstract:BACKGROUND:Receptors that couple via the stimulatory G protein, Gs, to adenylate cyclase and to a positive inotropic response have been extensively investigated in falling human heart. In contrast, much less is known about receptors, such as the A1-adenosine receptor, that couple to adenylate cyclase via the inhibitory...


    pub_type: 杂志文章


    authors: Hershberger RE,Feldman AM,Bristow MR

    更新日期:1991-04-01 00:00:00

  • Baroreflex sensitivity, clinical correlates, and cardiovascular mortality among patients with a first myocardial infarction. A prospective study.

    abstract::Experimental studies have shown that among dogs with a healed myocardial infarction, depressed baroreflex sensitivity (BRS) identifies a subgroup at higher risk for sudden death. We have examined the relation among BRS, several clinical cardiovascular variables, and subsequent mortality in 78 patients below the age of...


    pub_type: 杂志文章


    authors: La Rovere MT,Specchia G,Mortara A,Schwartz PJ

    更新日期:1988-10-01 00:00:00

  • Determinants of survival and left ventricular performance after mitral valve replacement. Department of Veterans Affairs Cooperative Study on Valvular Heart Disease.

    abstract::To determine how survival and clinical status were related to left ventricular (LV) size and systolic function after mitral valve replacement, 104 patients (48 mitral regurgitation [MR], 33 mitral stenosis [MS], and 23 MS/MR) with isolated mitral valve replacement were evaluated before and after surgery. Preoperative ...


    pub_type: 杂志文章


    authors: Crawford MH,Souchek J,Oprian CA,Miller DC,Rahimtoola S,Giacomini JC,Sethi G,Hammermeister KE

    更新日期:1990-04-01 00:00:00

  • Generic, simple risk stratification model for heart valve surgery.

    abstract:BACKGROUND:Heart valve surgery has an associated in-hospital mortality rate of 4% to 8%. This study aims to develop a simple risk model to predict the risk of in-hospital mortality for patients undergoing heart valve surgery to provide information to patients and clinicians and to facilitate institutional comparisons. ...


    pub_type: 杂志文章


    authors: Ambler G,Omar RZ,Royston P,Kinsman R,Keogh BE,Taylor KM

    更新日期:2005-07-12 00:00:00

  • Fluid restitution and blood volume redistribution in anesthetized rabbits in response to vasoactive drugs.

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    pub_type: 杂志文章


    authors: Anderson SM,Rich GF,Roos C,Lee LP,Lee JS

    更新日期:1994-07-01 00:00:00

  • Expression of perforin in infiltrating cells in murine hearts with acute myocarditis caused by coxsackievirus B3.

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    pub_type: 杂志文章


    authors: Seko Y,Shinkai Y,Kawasaki A,Yagita H,Okumura K,Takaku F,Yazaki Y

    更新日期:1991-08-01 00:00:00

  • Influenza infection promotes macrophage traffic into arteries of mice that is prevented by D-4F, an apolipoprotein A-I mimetic peptide.

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    pub_type: 杂志文章


    authors: Van Lenten BJ,Wagner AC,Anantharamaiah GM,Garber DW,Fishbein MC,Adhikary L,Nayak DP,Hama S,Navab M,Fogelman AM

    更新日期:2002-08-27 00:00:00

  • Proprotein convertase subtilisin kexin type 9 promotes intestinal overproduction of triglyceride-rich apolipoprotein B lipoproteins through both low-density lipoprotein receptor-dependent and -independent mechanisms.

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    pub_type: 杂志文章


    authors: Rashid S,Tavori H,Brown PE,Linton MF,He J,Giunzioni I,Fazio S

    更新日期:2014-07-29 00:00:00

  • Postinfarction gene therapy against transforming growth factor-beta signal modulates infarct tissue dynamics and attenuates left ventricular remodeling and heart failure.

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    pub_type: 杂志文章


    authors: Okada H,Takemura G,Kosai K,Li Y,Takahashi T,Esaki M,Yuge K,Miyata S,Maruyama R,Mikami A,Minatoguchi S,Fujiwara T,Fujiwara H

    更新日期:2005-05-17 00:00:00

  • Changes in phasic coronary blood flow velocity profile and relative coronary flow reserve in patients with hypertrophic obstructive cardiomyopathy.

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    pub_type: 杂志文章


    authors: Kyriakidis MK,Dernellis JM,Androulakis AE,Kelepeshis GA,Barbetseas J,Anastasakis AN,Trikas AG,Tentolouris CA,Gialafos JE,Toutouzas PK

    更新日期:1997-08-05 00:00:00

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    authors: Deguchi H,Pecheniuk NM,Elias DJ,Averell PM,Griffin JH

    更新日期:2005-08-09 00:00:00

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    pub_type: 杂志文章


    authors: Pandian NG,Kerber RE

    更新日期:1982-09-01 00:00:00

  • Circulating adhesion molecules in humans: role of hyperglycemia and hyperinsulinemia.

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    pub_type: 杂志文章


    authors: Marfella R,Esposito K,Giunta R,Coppola G,De Angelis L,Farzati B,Paolisso G,Giugliano D

    更新日期:2000-05-16 00:00:00

  • Prognostic value of pharmacological stress echocardiography is affected by concomitant antiischemic therapy at the time of testing.

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    pub_type: 杂志文章,多中心研究


    authors: Sicari R,Cortigiani L,Bigi R,Landi P,Raciti M,Picano E,Echo-Persantine International Cooperative (EPIC) Study Group.,Echo-Dobutamine International Cooperative (EDIC) Study Group.

    更新日期:2004-05-25 00:00:00

  • Exercise testing in children before and after surgical treatment of aortic stenosis.

    abstract::Twenty-three children with valvar or discrete subvalvar aortic stenosis underwent a controlled, progressive bicycle exercise test within 6 months before and 3-30 months after surgery for left ventricular outflow tract obstruction. The patients were divided into three groups according to the preoperative resting gradie...


    pub_type: 杂志文章


    authors: Whitmer JT,James FW,Kaplan S,Schwartz DC,Knight MJ

    更新日期:1981-02-01 00:00:00

  • Propranolol therapy in patients with acute myocardial infarction: the Beta-Blocker Heart Attack Trial.

    abstract::The Beta-Blocker Heart Attack Trial was a multicenter, randomized, double-blind, placebo-controlled trial of propranolol therapy in 3837 men and women with acute myocardial infarction. The patients began their treatment 5-21 days after hospital admission (mean 13.8 days). During an average follow-up of 25 months, ther...


    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Goldstein S

    更新日期:1983-06-01 00:00:00

  • The durability of porcine xenograft valves and conduits in children.

    abstract::One hundred four patients younger than 20 years of age underwent intracardiac xenograft valve replacement (n = 41) or extracardiac conduit implantation (n = 63). Long-term follow-up averaged 4.5 and 4.3 years, respectively, and cumulative follow-up totaled 344 patient-years (pt-yr). Thirty patients were followed more ...


    pub_type: 杂志文章


    authors: Miller DC,Stinson EB,Oyer PE,Billingham ME,Pitlick PT,Reitz BA,Jamieson SW,Baumgartner WA,Shumway NE

    更新日期:1982-08-01 00:00:00

  • Pulmonary hyperinflation and left ventricular mass: the Multi-Ethnic Study of Atherosclerosis COPD Study.

    abstract:BACKGROUND:Left ventricular (LV) mass is an important predictor of heart failure and cardiovascular mortality, yet determinants of LV mass are incompletely understood. Pulmonary hyperinflation in chronic obstructive pulmonary disease (COPD) may contribute to changes in intrathoracic pressure that increase LV wall stres...


    pub_type: 杂志文章


    authors: Smith BM,Kawut SM,Bluemke DA,Basner RC,Gomes AS,Hoffman E,Kalhan R,Lima JA,Liu CY,Michos ED,Prince MR,Rabbani L,Rabinowitz D,Shimbo D,Shea S,Barr RG

    更新日期:2013-04-09 00:00:00

  • Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association.

    abstract:BACKGROUND:Cardiovascular disease (CVD) is the leading cause of death in the United States and is responsible for 17% of national health expenditures. As the population ages, these costs are expected to increase substantially. METHODS AND RESULTS:To prepare for future cardiovascular care needs, the American Heart Asso...


    pub_type: 共识发展会议,杂志文章


    authors: Heidenreich PA,Trogdon JG,Khavjou OA,Butler J,Dracup K,Ezekowitz MD,Finkelstein EA,Hong Y,Johnston SC,Khera A,Lloyd-Jones DM,Nelson SA,Nichol G,Orenstein D,Wilson PW,Woo YJ,American Heart Association Advocacy Coordinating

    更新日期:2011-03-01 00:00:00

  • Severe aortic stenosis in patients 60 years of age or older: left ventricular function and 10-year survival after valve replacement.

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    pub_type: 杂志文章


    authors: Murphy ES,Lawson RM,Starr A,Rahimtoola SH

    更新日期:1981-08-01 00:00:00

  • Systolic and diastolic dysfunction in patients with clinical diagnosis of dilated cardiomyopathy. Relation to symptoms and prognosis.

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    pub_type: 杂志文章


    authors: Rihal CS,Nishimura RA,Hatle LK,Bailey KR,Tajik AJ

    更新日期:1994-12-01 00:00:00

  • Adult Advanced Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.

    abstract::This 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations for advanced life support includes updates on multiple advanced life support topics addressed with 3 different types of reviews. Topics were prioritized on the basis of both recen...


    pub_type: 杂志文章


    authors: Berg KM,Soar J,Andersen LW,Böttiger BW,Cacciola S,Callaway CW,Couper K,Cronberg T,D'Arrigo S,Deakin CD,Donnino MW,Drennan IR,Granfeldt A,Hoedemaekers CWE,Holmberg MJ,Hsu CH,Kamps M,Musiol S,Nation KJ,Neumar RW,Nic

    更新日期:2020-10-20 00:00:00

  • Heterogeneous atrial denervation creates substrate for sustained atrial fibrillation.

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    pub_type: 杂志文章


    authors: Olgin JE,Sih HJ,Hanish S,Jayachandran JV,Wu J,Zheng QH,Winkle W,Mulholland GK,Zipes DP,Hutchins G

    更新日期:1998-12-08 00:00:00

  • Measles virus nucleoprotein induces a regulatory immune response and reduces atherosclerosis in mice.

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    pub_type: 杂志文章


    authors: Ait-Oufella H,Horvat B,Kerdiles Y,Herbin O,Gourdy P,Khallou-Laschet J,Merval R,Esposito B,Tedgui A,Mallat Z

    更新日期:2007-10-09 00:00:00

  • Severe pulmonary hypertension associated with a small ventricular septal defect.

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    pub_type: 杂志文章


    authors: Bisset GS 3rd,Hirschfeld SS

    更新日期:1983-02-01 00:00:00

  • Noninvasive quantitation of valvular regurgitation by gated equilibrium radionuclide angiography.

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    pub_type: 杂志文章


    authors: Sorensen SG,O'Rourke RA,Chaudhuri TK

    更新日期:1980-11-01 00:00:00