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    Fragmented QRS is associated with subclinical left ventricular dysfunction in patients with chronic kidney disease
    (Acta Cardiologica, 2014) Adar, A.; Kiris, A.; Ulusoy, S.; Özkan, G.; Bektas, H.; Okutucu, S.; Onalan, O.
    Objective: We aimed to investigate the association of fragmented QRS (fQRS) with subclinical left ventricular (LV) dysfunction in patients with chronic kidney disease (CKD). Methods and results: Patients with CKD who had a normal LV ejection fraction (? 50%) were enrolled. The tissue Doppler-derived Tei index was measured for all patients. A Tei index of ? 0.5 was considered abnormal. Subclinical LV dysfunction was defined as the presence of an abnormal Tei index in the absence of impaired LV ejection fraction (< 50%). The fQRS was defined as the presence of an additional R wave (R') or notching of R or S wave or the presence of fragmentation in two contiguous ECG leads. The study group consisted of 82 patients (45 male, mean age 54 ± 14 years). Overall, prevalence of fQRS was 60% among CKD patients who had a preserved LV ejection fraction. Of these, 52 (63%) had an abnormal (? 0.5) and 30 (37%) a normal Tei index (< 0.5). The prevalence of fQRS was significantly higher in patients with an abnormal Tei index than in patients with a normal Tei index (71% vs. 40%, P = 0.006). Patients with an abnormal Tei index had a lower E/A ratio as compared to patients with a normal Tei index (P = 0.03). Groups were similar with respect to all other variables. In multivariate logistic regression analysis, the presence of fQRS was independently associated (OR 3.52, 95% CI 1.28-9.64) with the presence of an abnormal Tei index after adjustment for potential confounders. Conclusion: Fragmented QRS is independently associated with subclinical LV dysfunction in patients with CKD and normal ejection fraction.