Background: Cardiac involvement, as one of the life-threatening manifestations of systemic sclerosis (SSc), is chiefly caused by collagen fiber deposition in the myocardium, which subsequently leads to conduction abnormalities. In the present study, we aimed to investigate the prevalence and clinical significance of bundle branch blocks (BBBs) and the fragmented QRS complex (fQRS) in Iranian patients with SSc. Methods: Forty-one patients with SSc were enrolled from the outpatient SSc clinic of Shariati Hospital, Tehran University of Medical Sciences, between October 2016 and February 2017. Twelve-lead ECG was obtained and interpreted for BBBs and the fQRS. To adjust for the confounding effects of non– SSc-related cardiovascular risk factors, we calculated the Framingham risk score to estimate the risk of cardiovascular diseases. The associations between the studied conduction abnormalities and SSc cutaneous subtypes; disease duration; and the Medsger SSc severity scale of cutaneous, pulmonary, and vascular involvements were also analyzed. Results: The study population consisted of 41 Iranian patients with SSc at a mean age of 47. 48± 11. 57 years (82. 9% female). The prevalence of BBBs and the fQRS was 26. 8% and 36. 6%, respectively. The fQRS was associated with the limited cutaneous SSc subtype (OR: 0. 100, 95%CI: 0. 018– 0. 553, and P=0. 028). BBBs and the fQRS were not associated with either the Framingham risk score or the rest of the clinicodemographic variables. Conclusion: BBBs and the fQRS were more prevalent in our patients with SSc, without any association with the involvement of the other organs. These findings may suggest the independent pathophysiology of cardiac involvement in SSc.

BACKGROUND: Fragmented QRS (fQRS) is an electrocardiographic parameter, which could be assessed easily and non-invasively using surface electrocardiogram (ECG) and may have significant prognostic value. The present study aimed to evaluate the correlation between left ventricular ejection fraction (LVEF) and fQRS in surface ECG. METHODS: This study was conducted on 186 patients with acute ST-elevation myocardial infarction (STEMI). After primary percutaneous coronary intervention (PCI) and transferring the patients to the cardiac care unit (CCU), the patients were examined using echocardiography, and ejection fraction (EF) was assessed using the Simpson's method by a single cardiologist. Data analysis was performed using SPSS software. RESULTS: Among 186 eligible patients, 113 cases showed fQRS in the surface ECG. In total, 84. 9% of these patients were men, and 15. 1% were women (P < 0. 05). No significant correlation was observed between age and fQRS (P > 0. 05), as well as coronary artery disease (CAD) severity and fQRS (P > 0. 05). On the other hand, a statistically significant, reverse correlation was denoted between EF and fQRS in the surface ECG (P < 0. 05). In addition, significant relations were observed between the rate of ST-segment elevation and depression and fQRS (P < 0. 05). CONCLUSION: According to the obtained results, EF significantly decreased in the echocardiography of the patients with STEMI and fQRS in the surface ECG. Considering the cost-efficiency and accessibility of fQRS evaluation, it could be used for the assessment of various parameters in cardiology modalities such as cardiac magnetic resonance imaging (CMRI) and computed tomography (CT).

Background: Acute pulmonary embolism can quickly cause hemodynamic collapse and death. Recent studies have shown that different characteristics of electrocardiogram (ECG) can be used to predict the prognosis of patients. This study aimed to investigate the relative frequency of fragmented QRS in the ECG of patients with pulmonary embolism and its prognostic value. Methods: This study was conducted retrospectively. The files of 106 patients hospitalized with a diagnosis of pulmonary embolism from January 2016 to the end of March 2020 were selected and reviewed. The findings of the ECG, including the ST elevation in V1-V4 leads with and without T invention, right axis deviation, right bundle branch block (RBBB), PR, QRS, QTc intervals, type of treatment (thrombolysis or embolectomy), cardiogenic shock, mortality were collected. Finally, the data were recorded and analyzed in SPSS software Version 16. Results: Hypertension, dyslipidemia, and diabetes mellitus were the most frequent risk factors among the patients. The relative frequency of fragmented QRS, at least in one lead, was 26.2%. The use of thrombolysis, mechanical ventilation, embolectomy, cardiogenic shock, and in-hospital death was significantly higher among patients who had fragmented QRS (P<0.001). CTNI was significantly higher in patients with fragmented QRS (P=0.001). In patients with fragmented QRS large vessels, involvement was significantly higher. Conclusion: This study showed that the presence of fragmented QRS in the ECG of acute embolism patients has a significant relationship with cardiogenic shock, hospital mortality, and the need for advanced treatment methods such as intubation, embolectomy, and the use of thrombolysis.

Background-Patients with QRS fragmentation following myocardial infarction (MI) are at greater risk of cardiac death. Transthoracic echocardiography (TTE) can be used as a method for evaluating the coronary sinus blood flow (CSBF) and coronary sinus velocity time integral (CSVTI). The present study reports measurement of CSBF and CSVTI by TTE in 100 acute anterior MI cases, half of them with fragmented QRS.Methods: Our study included 100 patients with acute anterior MI in whom CSBF and CSVTI were measured by the use of TTE. Fifty of all the patients had fragmented QRS complex and 50 patients were without fragmented QRS complex, while there was no difference in terms of LVEF in both groups of study.Results-CSBF (303±126 ml/min vs.258±121 ml/min; p=0.001) and CSVTI (14.45±2.85 ml vs.10.85±2.69 ml; p=0.003) were significantly lower in the acute anterior MI patients with fragmented QRS in comparison with the patients with acute anterior MI without fragmented QRS.Conclusion-We conclude that CSBF and CSVTI can be measured by TTE in acute MI patients and these variables are reduced in acute anterior MI patients with fragmented QRS.

Background: Myocardial scars cause heterogeneous ventricular activation, which results in fragmented QRS (f-QRS) complexes and the resultant left ventricular (LV) dysfunction and dyssynchrony and thus further mortality. The accurate management of this patient population is essential to lessen mortality and improve the quality of life. Methods: The present cross-sectional study recruited 80 patients (40 with f-QRS and 40 with non– f-QRS) who underwent cardiac resynchronization therapy defibrillator (CRT-D) implantation and followed them up for 6 months. The 2 groups were compared, before and after CRT-D implantation, concerning the New York Heart Association functional class; the quality of life; the incidence of all arrhythmias, including tachyarrhythmias; echocardiographic findings; the number of hospitalization; and mortality. Results: The study population consisted of 80 patients at a mean age of 62. 05± 11. 25 years: 40 cases with f-QRS and 40 with non– f-QRS. Men comprised 68. 8% (n=55) of the patients. Ischemic cardiomyopathy was detected in 62. 5% of the patients, nonischemic cardiomyopathy in 37. 5%, and sinus rhythm in 76 cases. The mean values of the LV ejection fraction, the LV end-diastolic diameter, and the LV end-systolic diameter in both groups were 17. 12± 5. 77, 6. 44± 0. 81, and 5. 70± 0. 81, respectively (P<0. 05). An improvement was observed among the patients with non– f-QRS in echocardiography after CRT-D implantation, which was not related to the incidence of ischemic or nonischemic LV dysfunction. Dyspnea on exertion and mitral regurgitation improved in both groups (P>0. 05). Conclusions: The presence of f-QRS in patients with heart failure could confirm a diminished response to CRT-D implantation according to echocardiographic findings and could be considered an accurate patient selection guide.

Background: Cardiac involvement in beta-thalassemia major patients is an important cause of mortality. Therefore, in these patients, timely diagnosis of cardiac disorder is essential. Objectives: The present study aimed at determining the association between cardiac iron overload and fragmented QRS (fQRS). Methods: This cross-sectional study was conducted on 40 -TM patients, aged 5-40 years. The presence of fQRS was evaluated in 12-lead surface electrocardiograms. Cardiac T2* MRI was performed to determine the iron overload. The patients were divided into four groups of chelation therapy. Results: The mean age of patients was reported to be 22. 50  6. 75 years. The groups showed no significant difference regarding gender, age, or left ventricular ejection fraction. The presence of fQRS was detected in 10 patients (25%), while T2* value was lower than 20 ms in 10 patients (25%). The mean age of patients with and without fQRS was 26. 23 2. 71 and 19. 40 2. 61 years, respectively (P = 0. 001). The univariate analysis indicated that fQRS had a significant relationship with cardiac iron overload (OR = 5; 95% CI: 1. 04-23. 99; P < 0. 044). The multiple logistic regression analysis represented a significant association between iron overload and fQRS (OR = 5. 556; 95% CI: 1. 027-30. 049). The sensitivity and specificity of the fQRS against MRI were equal to 50% and 83. 3% respectively. Conclusions: The absence of fQRSonECGs could be agoodpredictor of the lack of cardiac iron overload in-TM patients. The results showed that fQRS might indicate the no need for close monitoring for cardiac overload with cardiac MRI and aggressive chelation therapy.

2Background: Systemic Sclerosis (SSc) is an autoimmune disease with multi-organ involvement mostly due to fibrosis and ectopic or excessive collagen fibers production in organs. Myocardial fibrosis is the main finding of cardiac involvement in patients with systemic sclerosis. In recent studies, the presence of Fragmented QRS complexes (FQRS) has been shown in the surface electrocardiogram in relation to fibrosis. Methods: The present study is a case-control study during March 2019 to February 2020 that was conducted in 148 patients with scleroderma referred to the Rheumatology clinic in Shariati Hospital and 101 non-ischemic individuals in the control group matched by age and sex with the patient group. All the medical records were reviewed and those who were low risk according to 10-year atherosclerotic cardiovascular disease (ASCVD) risk assessment were selected as case groups. Data of ECG were evaluated for availability of FQRS or conductive abnormalities and calculating PR, QRS, QT, QTc and Tp-e intervals. Results: Of the 141 patients with systemic sclerosis, 127(85.81%) were female and 21(14.19%) were male. In the control group, 81 women (80.2%) were present. 61(41.2%) of patients with scleroderma and 8(7.9%) of the control group in this study had FQRS changes in their electrocardiogram. In this study, QRS, QTc and Tp-e intervals were significantly higher in patients with systemic sclerosis compared to those in the control group. The frequency of FQRS, LAHB and LPHB in patients with systemic sclerosis was significantly more than control group. The relationship between PR, QRS, QTc, Tp-e intervals with age, length of disease onset and the severity of skin involvement was assessed. There was a significant correlation between PR-interval and age. Furthermore, there were a correlation between QRS interval and Rodnan skin score, Pulmonary Artery Pressure and Finger to Palm. It is also a meaningful correlation between QTc interval and Rodnan score. Conclusion: The FQRS finding in electrocardiogram in patients with systemic sclerosis, which has no obvious cardiac symptoms, may indicate myocardial fibrosis and predict future cardiac disorders.

Background and purpose: Cardiac magnetic resonance imaging (MRI) is a costly method to assess cardiac iron overload. The presence of fragmented QRS (fQRS) indicates changes due to iron overload in cardiac tissue. The aim of this study was to evaluate the correlation between fQRS and cardiac iron overload using cardiac MRI in patients with β-thalassemia major (β-TM). Materials and methods: This analytical cross-sectional study was conducted in 40 β-TM patients admitted to Arak Amir-Kabir Hospital, Iran 2018-2019. Cardiac T2* MRI was performed and values of less than 20 ms were considered as cardiac iron overload. The patients were divided into two groups (<20 and >20 ms). The presence of fQRS was assessed on 12-lead surface electrocardiogram (ECG) and compared between two groups. Results: There was a positive correlation between T2*MRI and serum ferritin (r= 0. 041, P=0. 657) and hemoglobin levels (r=0. 057, P=0. 540). The mean T2*MRI in patients with fQRS (18. 43± 7. 24) was significantly lower than patients without fQRS (26. 47± 6. 15) (P=0. 001). We found a negative correlation between T2*MRI and fQRS (r=-0. 048, P=0. 001). Conclusion: The presence of fQRS on ECGs could be a good predictor of cardiac iron overload in β-TM patients. It is believed that fQRS can indicate this change in electrocardiography and shows the need for more accurate monitoring for cardiac overload and aggressive chelation therapy.