Fragmented QRS on 12-Lead Electrocardiogram Predicts Long-Term Prognosis in Patients with Cardiac Sarcoidosis

20 Pages Posted: 21 Jan 2022

See all articles by Hikaru Hagiwara

Hikaru Hagiwara

Hokkaido University - Department of Cardiovascular Medicine

Masaya Watanabe

Hokkaido University - Department of Cardiovascular Medicine

Takehide Kadosaka

Hokkaido University - Department of Cardiovascular Medicine

Takuya Koizumi

Hokkaido University - Department of Cardiovascular Medicine

Yuta Kobayashi

Hokkaido University - Department of Cardiovascular Medicine

Taro Koya

Hokkaido University - Department of Cardiovascular Medicine

Motoki Nakao

Hokkaido University - Department of Cardiovascular Medicine

Satonori Tsuneta

Hokkaido University - Department of Diagnostic Imaging

Yoshiya Kato

Hokkaido University - Department of Cardiovascular Medicine

Hirokazu Komoriyama

Hokkaido University - Department of Cardiovascular Medicine

Rui Kamada

Hokkaido University - Department of Cardiovascular Medicine

Toshiyuki Nagai

Hokkaido University - Department of Cardiovascular Medicine

Kohsuke Kudo

Hokkaido University - Department of Diagnostic Imaging

Toshihisa Anzai

Hokkaido University - Department of Cardiovascular Medicine

Abstract

Fragmented QRS (fQRS) on a 12-lead electrocardiogram is a marker of fatal arrhythmias or cardiac adverse events in patients with ischemic and non-ischemic cardiomyopathy. Nonetheless, the association between fQRS and clinical outcomes in patients with cardiac sarcoidosis (CS) remains unclear. Herein, we investigated whether fQRS is associated with long-term clinical outcomes in patients with CS.

A total of 78 patients who received immunosuppressive therapy (IST) for clinically diagnosed CS were retrospectively examined. Patients were classified into two groups according to the presence (n=19) or absence (n=59) of fQRS on electrocardiogram before IST. The primary outcome was the composite event of all-cause death, ventricular tachyarrhythmias (VTs), and hospitalization for heart failure. Results of late gadolinium enhancement on cardiac magnetic resonance imaging were also analyzed.

During a median follow-up period of 3.7 years (interquartile range: 1.6–6.2 years), the primary outcome occurred more frequently in patients with fQRS than in those without fQRS (47% vs. 13%, log-rank p=0.002). Multivariable Cox regression analyses showed that fQRS was an independent determinant of the primary outcome. The incidence of VTs within 12 months of IST initiation was comparable between the two groups; however, late-onset VTs, defined as those occurring ≥12 months after IST initiation, occurred more frequently in the fQRS group (21% vs. 2%, log-rank p=0.002). The scar zone and scar border zone were greater in patients with fQRS than in those without.

We conclude that fQRS is an independent predictor of adverse events, particularly late-onset VTs, in patients with CS.

Note:
Funding Information: None.

Declaration of Interests The authors have no conflicts of interest to declare.

Ethical Approval Statement: This observational, retrospective study was approved by the ethics committee of Hokkaido University Hospital (020-0164). The participants were informed of the study via the information posted at our institution.

Keywords: cardiac sarcoidosis, electrocardiography, fragmented QRS, immunosuppressive therapy, ventricular arrhythmias

Suggested Citation

Hagiwara, Hikaru and Watanabe, Masaya and Kadosaka, Takehide and Koizumi, Takuya and Kobayashi, Yuta and Koya, Taro and Nakao, Motoki and Tsuneta, Satonori and Kato, Yoshiya and Komoriyama, Hirokazu and Kamada, Rui and Nagai, Toshiyuki and Kudo, Kohsuke and Anzai, Toshihisa, Fragmented QRS on 12-Lead Electrocardiogram Predicts Long-Term Prognosis in Patients with Cardiac Sarcoidosis. Available at SSRN: https://ssrn.com/abstract=4003868 or http://dx.doi.org/10.2139/ssrn.4003868

Hikaru Hagiwara (Contact Author)

Hokkaido University - Department of Cardiovascular Medicine ( email )

Japan

Masaya Watanabe

Hokkaido University - Department of Cardiovascular Medicine ( email )

Japan

Takehide Kadosaka

Hokkaido University - Department of Cardiovascular Medicine ( email )

Japan

Takuya Koizumi

Hokkaido University - Department of Cardiovascular Medicine ( email )

Japan

Yuta Kobayashi

Hokkaido University - Department of Cardiovascular Medicine ( email )

Japan

Taro Koya

Hokkaido University - Department of Cardiovascular Medicine ( email )

Japan

Motoki Nakao

Hokkaido University - Department of Cardiovascular Medicine ( email )

Japan

Satonori Tsuneta

Hokkaido University - Department of Diagnostic Imaging ( email )

Sapporo
Japan

Yoshiya Kato

Hokkaido University - Department of Cardiovascular Medicine ( email )

Japan

Hirokazu Komoriyama

Hokkaido University - Department of Cardiovascular Medicine ( email )

Japan

Rui Kamada

Hokkaido University - Department of Cardiovascular Medicine ( email )

Japan

Toshiyuki Nagai

Hokkaido University - Department of Cardiovascular Medicine ( email )

Japan

Kohsuke Kudo

Hokkaido University - Department of Diagnostic Imaging ( email )

Sapporo
Japan

Toshihisa Anzai

Hokkaido University - Department of Cardiovascular Medicine ( email )

Japan

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