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

Abstract:

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.

journal_name

Circulation

journal_title

Circulation

authors

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

doi

10.1161/CIRCULATIONAHA.105.595892

subject

Has Abstract

pub_date

2006-05-30 00:00:00

pages

2495-501

issue

21

eissn

0009-7322

issn

1524-4539

pii

CIRCULATIONAHA.105.595892

journal_volume

113

pub_type

杂志文章
  • Aldosterone synthase inhibitor ameliorates angiotensin II-induced organ damage.

    abstract:BACKGROUND:Aldosterone and angiotensin (Ang) II both may cause organ damage. Circulating aldosterone is produced in the adrenals; however, local cardiac synthesis has been reported. Aldosterone concentrations depend on the activity of aldosterone synthase (CYP11B2). We tested the hypothesis that reducing aldosterone by...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/CIRCULATIONAHA.104.521625

    authors: Fiebeler A,Nussberger J,Shagdarsuren E,Rong S,Hilfenhaus G,Al-Saadi N,Dechend R,Wellner M,Meiners S,Maser-Gluth C,Jeng AY,Webb RL,Luft FC,Muller DN

    更新日期:2005-06-14 00:00:00

  • Perioperative myocardial infarction after coronary artery bypass surgery. Clinical significance and approach to risk stratification.

    abstract::The clinical significance of perioperative myocardial infarction (MI) after coronary artery bypass surgery is not known. Therefore, strategies for the risk stratification of these patients do not exist. This study was undertaken to define the effect of perioperative MI on prognosis after discharge from the hospital an...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.82.3.903

    authors: Force T,Hibberd P,Weeks G,Kemper AJ,Bloomfield P,Tow D,Josa M,Khuri S,Parisi AF

    更新日期:1990-09-01 00:00:00

  • Detection of adenoviral genome in the myocardium of adult patients with idiopathic left ventricular dysfunction.

    abstract:BACKGROUND:The use of molecular biological techniques has demonstrated the importance of enteroviral infection of the myocardium in the pathogenesis of myocarditis and dilated cardiomyopathy in adults and adenovirus and enterovirus infection in children. The aim of this study was to determine the frequency of adenovira...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.99.10.1348

    authors: Pauschinger M,Bowles NE,Fuentes-Garcia FJ,Pham V,Kühl U,Schwimmbeck PL,Schultheiss HP,Towbin JA

    更新日期:1999-03-16 00:00:00

  • Two-dimensional echocardiography in experimental coronary stenosis. I. Sensitivity and specificity in detecting transient myocardial dyskinesis: comparison with sonomicrometers.

    abstract::The purpose of this study was to assess the sensitivity and specificity of two-dimensional echocardiography in detecting ischemia-induced transient myocardial dyskinesis. We prepared an open-chest dog model of severe coronary stenosis (90% reduction of circumflex coronary artery diameter) and induced ischemia by acute...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.66.3.597

    authors: Pandian NG,Kerber RE

    更新日期:1982-09-01 00:00:00

  • Use of a novel endoscopic catheter for direct visualization and ablation in an ovine model of chronic myocardial infarction.

    abstract:BACKGROUND:Defining the arrhythmogenic substrate is essential for successful ablation of scar-related ventricular tachycardia. The visual characteristics of endocardial ischemic scar have not been described in vivo. The goal of this study was (1) to quantify the visual characteristics of normal tissue, scar border zone...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/CIRCULATIONAHA.112.112540

    authors: Betensky BP,Jauregui M,Campos B,Michele J,Marchlinski FE,Oley L,Wylie B,Robinson D,Gerstenfeld EP

    更新日期:2012-10-23 00:00:00

  • Cardioprotective mechanism of ischemic preconditioning is impaired by postinfarct ventricular remodeling through angiotensin II type 1 receptor activation.

    abstract:BACKGROUND:Activation of protein kinase C-linked receptors and subsequent opening of the mitochondrial ATP-sensitive K(+) (mitoK(ATP)) channel are crucial in preconditioning (PC). This study examined whether postinfarct ventricular remodeling interferes with the PC mechanism. METHODS AND RESULTS:Two weeks before isola...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.102.4.458

    authors: Miki T,Miura T,Tsuchida A,Nakano A,Hasegawa T,Fukuma T,Shimamoto K

    更新日期:2000-07-25 00:00:00

  • Epidemiology and cause-specific outcome of hypertrophic cardiomyopathy in children: findings from the Pediatric Cardiomyopathy Registry.

    abstract:BACKGROUND:Current information on the epidemiology and outcomes of hypertrophic cardiomyopathy (HCM) in children is limited by disease diversity and small case series. METHODS AND RESULTS:The Pediatric Cardiomyopathy Registry has collected prospective and retrospective data on children diagnosed with HCM since 1990. W...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/CIRCULATIONAHA.106.621185

    authors: Colan SD,Lipshultz SE,Lowe AM,Sleeper LA,Messere J,Cox GF,Lurie PR,Orav EJ,Towbin JA

    更新日期:2007-02-13 00:00:00

  • Limitations of routine long-term electrocardiographic monitoring to assess ventricular ectopic frequency.

    abstract::Variations in the frequency of ventricular premature depolarizations (VPDs) were evaluated with three consecutive 24-hour long-term electrocardiography monitor recordings from 15 clinically stable patients with various cardiac disorders. Mean hourly VPD frequencies ranged from 37--1,801 per hour. Data were subjected t...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.58.3.408

    authors: Morganroth J,Michelson EL,Horowitz LN,Josephson ME,Pearlman AS,Dunkman WB

    更新日期:1978-09-01 00:00:00

  • An oligosaccharide sialyl-Lewis(x) analogue does not reduce myocardial infarct size after ischemia and reperfusion in dogs.

    abstract:BACKGROUND:Polymorphonuclear leukocytes, particularly neutrophils, are important mediators of ischemia/reperfusion-induced myocardial and coronary vascular injury. The selectin family of glycoprotein receptors mediates neutrophil "rolling," a loose, transient adhesion to the coronary endothelium that precedes the firme...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.94.3.542

    authors: Gill EA,Kong Y,Horwitz LD

    更新日期:1996-08-01 00:00:00

  • Left ventricular remodeling in transgenic mice with cardiac restricted overexpression of tumor necrosis factor.

    abstract:BACKGROUND:The mechanisms responsible for tumor necrosis factor (TNF)-induced LV structural remodeling in the adult heart are not known. METHODS AND RESULTS:We generated a line of transgenic mice (MHCsTNF) with cardiac restricted overexpression of TNF that develop progressive LV dilation/remodeling from 4 to 12 weeks ...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/hc3401.093154

    authors: Sivasubramanian N,Coker ML,Kurrelmeyer KM,MacLellan WR,DeMayo FJ,Spinale FG,Mann DL

    更新日期:2001-08-14 00:00:00

  • Effects of unilateral stellate ganglion stimulation and ablation on electrophysiologic changes induced by acute myocardial ischemia in dogs.

    abstract::We recorded direct-current extracellular electrograms simultaneously from 60 left ventricular epicardial sites in 38 alpha-chloralose-anesthetized dogs during repeated, 5 min coronary arterial occlusions. In each dog recordings made during control occlusions were compared with those made in occlusions after, or during...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.72.3.585

    authors: Janse MJ,Schwartz PJ,Wilms-Schopman F,Peters RJ,Durrer D

    更新日期:1985-09-01 00:00:00

  • Restoration of microvascular function in the infarct-related artery by intracoronary transplantation of bone marrow progenitor cells in patients with acute myocardial infarction: the Doppler Substudy of the Reinfusion of Enriched Progenitor Cells and Infa

    abstract:BACKGROUND:The Doppler Substudy of the randomized, double-blind, placebo-controlled Reinfusion of Enriched Progenitor Cells and Infarct Remodeling in Acute Myocardial Infarction (REPAIR-AMI) trial aimed to investigate the effects of intracoronary infusion of bone marrow-derived progenitor cells (BMCs) on coronary blood...

    journal_title:Circulation

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1161/CIRCULATIONAHA.106.671545

    authors: Erbs S,Linke A,Schächinger V,Assmus B,Thiele H,Diederich KW,Hoffmann C,Dimmeler S,Tonn T,Hambrecht R,Zeiher AM,Schuler G

    更新日期:2007-07-24 00:00:00

  • Inhibition of intimal hyperplasia after balloon injury by antibodies to intercellular adhesion molecule-1 and lymphocyte function-associated antigen-1.

    abstract:BACKGROUND:Although intercellular adhesion molecule-1 (ICAM-1) is known to be expressed in balloon-injured arteries, it remains unknown whether ICAM-1 plays a role in the progression of intimal hyperplasia (IH) induced by balloon injury. METHODS AND RESULTS:We examined the ICAM-1 expression in rat carotid arteries at ...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.95.6.1515

    authors: Yasukawa H,Imaizumi T,Matsuoka H,Nakashima A,Morimatsu M

    更新日期:1997-03-18 00:00:00

  • Interrelations between brachial endothelial function and carotid intima-media thickness in young adults: the cardiovascular risk in young Finns study.

    abstract:BACKGROUND:Endothelial vasodilator dysfunction and carotid intima-media thickening (IMT) are 2 indicators of subclinical cardiovascular disease. We examined their correlation and interaction with risk factors in a large, community-based cohort of young adults. METHODS AND RESULTS:As part of the longitudinal Cardiovasc...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.CIR.0000147540.88559.00

    authors: Juonala M,Viikari JS,Laitinen T,Marniemi J,Helenius H,Rönnemaa T,Raitakari OT

    更新日期:2004-11-02 00:00:00

  • Ventricular tachycardia in infancy: evidence for a reentrant mechanism.

    abstract::Ventricular tachycardia is unusual in infancy. Three infants are described in whom this arrhythmia was documented by electrophysiologic studies. The ability to start and terminate this rhythm by critically timed premature ventricular stimulation suggests a reentrant mechanism. All three patients have remained free of ...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.62.2.401

    authors: Gaum WE,Schwartz DC,Kaplan S

    更新日期:1980-08-01 00:00:00

  • Echocardiographic markers of elevated pulmonary pressure and left ventricular diastolic dysfunction are associated with exercise intolerance in adults and adolescents with homozygous sickle cell anemia in the United States and United Kingdom.

    abstract:BACKGROUND:Noninvasively assessed pulmonary pressure elevations and left ventricular (LV) diastolic dysfunction are associated with increased mortality in adults with sickle cell disease, but their relationship to exercise intolerance has not been evaluated prospectively. METHODS AND RESULTS:Echocardiography, 6-minute...

    journal_title:Circulation

    pub_type: 临床试验,杂志文章,多中心研究

    doi:10.1161/CIRCULATIONAHA.111.032920

    authors: Sachdev V,Kato GJ,Gibbs JS,Barst RJ,Machado RF,Nouraie M,Hassell KL,Little JA,Schraufnagel DE,Krishnamurti L,Novelli EM,Girgis RE,Morris CR,Rosenzweig EB,Badesch DB,Lanzkron S,Castro OL,Taylor JG 6th,Hannoush H,Gold

    更新日期:2011-09-27 00:00:00

  • Cytosolic heat shock protein 60, hypoxia, and apoptosis.

    abstract:BACKGROUND:Heat shock protein (HSP)60 is an abundant protein found primarily in the mitochondria, though 15% to 20% is found in the cytosol. Previously we observed that HSP60 complexes with bax in the cytosol. Reduction in HSP60 precipitates translocation of bax to the mitochondria and apoptosis. We hypothesized that H...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.0000038112.64503.6e

    authors: Gupta S,Knowlton AA

    更新日期:2002-11-19 00:00:00

  • Missense mutations in plakophilin-2 cause sodium current deficit and associate with a Brugada syndrome phenotype.

    abstract:BACKGROUND:Brugada syndrome (BrS) primarily associates with the loss of sodium channel function. Previous studies showed features consistent with sodium current (INa) deficit in patients carrying desmosomal mutations, diagnosed with arrhythmogenic cardiomyopathy (or arrhythmogenic right ventricular cardiomyopathy). Exp...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/CIRCULATIONAHA.113.003077

    authors: Cerrone M,Lin X,Zhang M,Agullo-Pascual E,Pfenniger A,Chkourko Gusky H,Novelli V,Kim C,Tirasawadichai T,Judge DP,Rothenberg E,Chen HS,Napolitano C,Priori SG,Delmar M

    更新日期:2014-03-11 00:00:00

  • Neurohumoral activation in preclinical heart failure. Remodeling and the potential for intervention.

    abstract::Congestive heart failure is often preceded by a latent or preclinical phase in which patients are relatively asymptomatic. During this period, there is neuroendocrine activation, left ventricular dysfunction, and remodeling of the heart. The extent to which these activities are interrelated is unclear, but it appears ...

    journal_title:Circulation

    pub_type: 杂志文章,评审

    doi:

    authors: Francis GS,McDonald KM,Cohn JN

    更新日期:1993-05-01 00:00:00

  • Analysis of left ventricular function from multiple gated acquisition cardiac blood pool imaging. Comparison to contrast angiography.

    abstract::Global ventricular function was evaluated by both multiple gated cardiac blood pool scans (MUGA) and contrast ventriculograms in a group of 17 patients with suspected coronary artery disease. The contrast ventriculograms were analyzed frame by frame to generate a volume versus time curve for each patient, while the tr...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.56.6.1024

    authors: Burow RD,Strauss HW,Singleton R,Pond M,Rehn T,Bailey IK,Griffith LC,Nickoloff E,Pitt B

    更新日期:1977-12-01 00:00:00

  • Effects of gap geometry on conduction through discontinuous radiofrequency lesions.

    abstract:BACKGROUND:Gaps of sufficient cross-sectional dimensions within linear radiofrequency (RF) lesions may allow conduction through the lesion. The purpose of this study was to examine the effects of different gap geometries on conduction through discontinuous RF lesions. METHODS AND RESULTS:Radiofrequency lesions were cr...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/CIRCULATIONAHA.105.596593

    authors: Pérez FJ,Wood MA,Schubert CM

    更新日期:2006-04-11 00:00:00

  • Toll-like receptor 4-dependent microglial activation mediates spinal cord ischemia-reperfusion injury.

    abstract:BACKGROUND:Paraplegia continues to complicate thoracoabdominal aortic interventions. The elusive mechanism of spinal cord ischemia-reperfusion injury has delayed the development of pharmacological adjuncts. Microglia, the resident macrophages of the central nervous system, can have pathological responses after a variet...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/CIRCULATIONAHA.112.000024

    authors: Bell MT,Puskas F,Agoston VA,Cleveland JC Jr,Freeman KA,Gamboni F,Herson PS,Meng X,Smith PD,Weyant MJ,Fullerton DA,Reece TB

    更新日期:2013-09-10 00:00:00

  • Intra-arterial stenting in the atherosclerotic rabbit.

    abstract::The major problem associated with percutaneous transluminal coronary angioplasty is recurrence of the stenotic lesion. Balloon catheter-mounted intracoronary stent devices may reduce restenosis by improving luminal morphology and flow characteristics. This study assessed the effects of a stainless steel wire, interdig...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.78.3.646

    authors: Robinson KA,Roubin GS,Siegel RJ,Black AJ,Apkarian RP,King SB 3rd

    更新日期:1988-09-01 00:00:00

  • Deleterious effect of coronary brachytherapy on vasomotor response to exercise.

    abstract:BACKGROUND:Intracoronary radiotherapy (brachytherapy) has been proposed as treatment option for in-stent restenosis. Long-term results of brachytherapy with regard to vascular integrity and vasomotor responsiveness are unknown. The purpose of the present study was to determine the vasomotor response after brachytherapy...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.CIR.0000134956.96543.4F

    authors: Togni M,Windecker S,Wenaweser P,Tueller D,Kaisaier A,Maier W,Meier B,Hess OM

    更新日期:2004-07-13 00:00:00

  • Cost-effectiveness of dual-chamber pacing compared with ventricular pacing for sinus node dysfunction.

    abstract:BACKGROUND:Compared with single-chamber ventricular pacing, dual-chamber pacing can reduce adverse events and, as a result, improve quality of life in patients paced for sick sinus syndrome. It is not clear, however, how these benefits compare with the increased cost of dual-chamber pacemakers. METHODS AND RESULTS:We ...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.CIR.0000151810.69732.41

    authors: Rinfret S,Cohen DJ,Lamas GA,Fleischmann KE,Weinstein MC,Orav J,Schron E,Lee KL,Goldman L

    更新日期:2005-01-18 00:00:00

  • Impact of pulmonary valve replacement on arrhythmia propensity late after repair of tetralogy of Fallot.

    abstract:BACKGROUND:Chronic pulmonary regurgitation after repair of tetralogy of Fallot (TOF) may lead to right ventricular dilatation, which may be accompanied by ventricular tachycardia and sudden death. We aimed to examine the effects of pulmonary valve replacement (PVR) on (1) certain electrocardiographic markers predictive...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.103.20.2489

    authors: Therrien J,Siu SC,Harris L,Dore A,Niwa K,Janousek J,Williams WG,Webb G,Gatzoulis MA

    更新日期:2001-05-22 00:00:00

  • Vascular disease in mice with a dysfunctional circadian clock.

    abstract:BACKGROUND:Cardiovascular disease is the leading cause of death for both men and women in the United States and the world. A profound pattern exists in the time of day at which the death occurs; it is in the morning, when the endothelium is most vulnerable and blood pressure surges, that stroke and heart attack most fr...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/CIRCULATIONAHA.108.827477

    authors: Anea CB,Zhang M,Stepp DW,Simkins GB,Reed G,Fulton DJ,Rudic RD

    更新日期:2009-03-24 00:00:00

  • Coronary sinus morphology in patients with atrioventricular junctional reentry tachycardia and other supraventricular tachyarrhythmias.

    abstract:BACKGROUND:Coronary sinus access by electrode catheters is easier in patients with atrioventricular junctional reentry tachycardia (AVJRT) than in patients with other supraventricular tachyarrhythmias. The reason for this has not been addressed. METHODS AND RESULTS:The size and shape of the proximal coronary sinus wer...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.92.3.436

    authors: Doig JC,Saito J,Harris L,Downar E

    更新日期:1995-08-01 00:00:00

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

    abstract:BACKGROUND:The aim of this study was to determine whether antianginal medications affect the prognostic value of pharmacological stress echocardiography. METHODS AND RESULTS:From the EPIC-EDIC Data Bank, 7333 patients (5452 men; age; 59+/-10 years) underwent pharmacological stress echocardiography with either high-dos...

    journal_title:Circulation

    pub_type: 杂志文章,多中心研究

    doi:10.1161/01.CIR.0000127427.03361.5E

    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

  • Randomized COMparison of platelet inhibition with abciximab, tiRofiban and eptifibatide during percutaneous coronary intervention in acute coronary syndromes: the COMPARE trial. Comparison Of Measurements of Platelet aggregation with Aggrastat, Reopro, an

    abstract:BACKGROUND:The relative anti-aggregatory effects of currently prescribed platelet glycoprotein IIb/IIIa receptor antagonists during and after percutaneous coronary intervention for acute coronary syndromes have not been established. METHODS AND RESULTS:We randomized 70 acute coronary syndrome patients undergoing percu...

    journal_title:Circulation

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1161/01.cir.0000029744.01096.1f

    authors: Batchelor WB,Tolleson TR,Huang Y,Larsen RL,Mantell RM,Dillard P,Davidian M,Zhang D,Cantor WJ,Sketch MH Jr,Ohman EM,Zidar JP,Gretler D,DiBattiste PM,Tcheng JE,Califf RM,Harrington RA

    更新日期:2002-09-17 00:00:00