The role of the presence of fragmented QRS in predicting disease severity in patients with pulmonary hypertension

Pulmonary arterial hypertension is a malignant pulmonary vascular disease primarily caused by increased pulmonary vascular resistance, which leads to right ventricular hypertrophy, fibrosis, right heart failure and death. Fragmented QRS (fQRS) indicates non-homogeneous ventricular activity caused by myocardial fibrosis. This study aims to investigate the importance of fQRS in patients with pulmonary hypertension (PH) and to determine the role of the presence of fQRS in indicating the severity of the disease. The study included 94 (85 patient group 1 PH and 9 patient group 4 PH) patients. The patients were divided into two groups according to the presence of fQRS in their surface electrocardiography (ECG). The patients' laboratory, transthoracic echocardiography, and right heart catheterization parameters were compared between the two groups . FQRS was detected in 55 (58%) patients, and the mean age of these patients was 51.8±18.0, and 29.1% of them were male. Systolic pulmonary arterial pressure (PAP) measured by transthoracic echocardiography (p<0.001), pulmonary vascular resistance (PVR) (p<0.001) and mean, diastolic, systolic PAP (p=0.001, p<0.001, p<0.001) measured by right heart catheterization were found to be higher in patients with fQRS presence in their surface ECGs. Moreover, fQRS was found to be of high significance in predicting PVR. (95% CI 2.147-6.182; p<0.001). In conclusion, when evaluating patients with pulmonary hypertension, it will be helpful in our clinical practice to assume that patients with fQRS on surface ECG are more affected hemodynamically and to start combination therapy early or follow up on these patients at shorter intervals.