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Int J Cardiol. 2013 Oct 3;168(3):2008-13. doi: 10.1016/j.ijcard.2012.12.086. Epub 2013 Jan 19.

Fragmented QRS complexes are not hallmarks of myocardial injury as detected by cardiac magnetic resonance imaging in patients with acute myocardial infarction.

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  • 1Cardiology Division, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea.



Q waves on a 12-lead electrocardiography (ECG) are considered to be classic hallmarks of prior myocardial infarction. However, one study suggested that the fragmented QRS complex (fQRS) on ECG is a highly sensitive and specific marker of myocardial scarring on a nuclear stress test. The study aimed to investigate the diagnostic accuracy of fragmented QRS complexes compared with Q waves for myocardial injury detected by delayed contrast-enhanced cardiovascular magnetic resonance imaging (DE-CMRI) in subjects with acute myocardial infarction.


Electrocardiograms of 190 subjects with myocardial infarction who underwent DE-CMR were analyzed. fQRS was defined by the presence of an additional R wave (R″), or notching of the S wave, or more than one R' in two contiguous leads.


Delayed enhancement was observed in 180 (94.7%) patients. Transmural enhancement was noted in 78 (43.3%) and subendocardial enhancement in 102 (56.7%) patients. The sensitivity and specificity of Q waved and fQRS for diagnosing delayed enhancement were 59.4% vs. 66.7% and 90.0% vs. 40.0%. The area under the receiver-operator characteristics curve of delayed enhancement was 0.75 for Q waves and 0.53 for fQRS (p=0.04). The areas under the ROC curves of the transmurality of delayed enhancement were 0.44 for fQRS and 0.58 for Q waves (p=0.73).


fQRS has poor accuracy for the detection of myocardial injury compared with Q waves. fQRS and Q waves are not valuable tools for the diagnosis transmural irreversible myocardial injury in acute myocardial infarction.

Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.


Electrocardiography; Magnetic resonance imaging; Myocardial infarction

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