PMID- 32562382
OWN - NLM
STAT- MEDLINE
DCOM- 20210621
LR  - 20210621
IS  - 2055-5822 (Electronic)
IS  - 2055-5822 (Linking)
VI  - 7
IP  - 5
DP  - 2020 Oct
TI  - QRS fragmentation as a possible electrocardiographic diagnostic marker in 
      patients with acute myocarditis: preliminary histopathological validation.
PG  - 2527-2533
LID - 10.1002/ehf2.12821 [doi]
AB  - AIMS: We aim to assess the reproducibility of QRS fragmentation (fQRS) on a 
      multi-centre dataset of patients with acute myocarditis (AM), including a 
      histopathological validation in a subgroup with biopsy-proven disease. 
      Electrocardiogram (ECG) in patients with myocarditis is usually considered 
      aspecific. ST changes and conduction anomalies have been commonly reported so 
      far. We have previously described fQRS in patients with AM. METHODS AND RESULTS: 
      Patients admitted between 2008 and 2019 in two centres with a diagnosis of AM 
      were included. Standard ECG, echocardiography, and cardiac magnetic resonance 
      (CMR) findings were recorded at baseline and at follow-up (FU). Eighty patients 
      were analysed, 66 men (82%), with median age of 34 (26-43) years. Twenty-two 
      patients had biopsy-proven AM. At presentation, 61 patients (76%) displayed fQRS. 
      Median ejection fraction (EF) was 55% (43-60). Seventy-two patients (90%) 
      underwent CMR and displayed late gadolinium enhancement (LGE). ECG leads showed 
      that fQRS correlated with distribution of LGE. In patients with positive biopsy, 
      fQRS was present in 18 (81%). Median FU was 419 days (224-956). Complete FU was 
      available for 64 patients (80%), and 33 patients (52%) displayed persistence of 
      fQRS. Median EF was 60% (57-64). Eleven patients underwent a repeated biopsy at 
      FU, eight of whom had persistent inflammation and fQRS. Fifteen patients (23%) 
      had ventricular tachycardia, 14 of whom still showed fQRS. CONCLUSIONS: In this 
      cohort fQRS was confirmed as an additional useful ECG sign. Persistence of fQRS 
      was associated with ongoing inflammation and with a poorer outcome in terms of 
      ventricular function and occurrence of arrhythmias.
CI  - (c) 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on 
      behalf of the European Society of Cardiology.
FAU - Ferrero, Paolo
AU  - Ferrero P
AUID- ORCID: 0000-0001-7967-7417
AD  - Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy.
FAU - Piazza, Isabelle
AU  - Piazza I
AUID- ORCID: 0000-0002-1316-8107
AD  - Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy.
FAU - Kuhl, Uwe
AU  - Kuhl U
AD  - Department of Cardiology, University of Medicine Berlin, Charite, Campus Virchow 
      Klinikum, Berlin, Germany.
FAU - Grosu, Aurelia
AU  - Grosu A
AD  - Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy.
FAU - Tschope, Carsten
AU  - Tschope C
AD  - Department of Cardiology, University of Medicine Berlin, Charite, Campus Virchow 
      Klinikum, Berlin, Germany.
AD  - DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, 
      Germany.
AD  - Berlin Institute of Health/Center for Regenerative Therapy (BCRT), Berlin, 
      Germany.
FAU - Senni, Michele
AU  - Senni M
AD  - Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy.
LA  - eng
PT  - Journal Article
DEP - 20200619
PL  - England
TA  - ESC Heart Fail
JT  - ESC heart failure
JID - 101669191
RN  - 0 (Contrast Media)
RN  - AU0V1LM3JT (Gadolinium)
SB  - IM
MH  - Adult
MH  - Contrast Media
MH  - Electrocardiography
MH  - Gadolinium
MH  - Humans
MH  - Male
MH  - *Myocarditis/diagnosis/epidemiology
MH  - Reproducibility of Results
PMC - PMC7524046
OTO - NOTNLM
OT  - Diagnosis
OT  - Myocarditis
OT  - QRS fragmentation
COIS- None declared.
EDAT- 2020/06/21 06:00
MHDA- 2021/06/22 06:00
PMCR- 2020/06/19
CRDT- 2020/06/21 06:00
PHST- 2020/03/10 00:00 [received]
PHST- 2020/05/17 00:00 [revised]
PHST- 2020/05/20 00:00 [accepted]
PHST- 2020/06/21 06:00 [pubmed]
PHST- 2021/06/22 06:00 [medline]
PHST- 2020/06/21 06:00 [entrez]
PHST- 2020/06/19 00:00 [pmc-release]
AID - EHF212821 [pii]
AID - 10.1002/ehf2.12821 [doi]
PST - ppublish
SO  - ESC Heart Fail. 2020 Oct;7(5):2527-2533. doi: 10.1002/ehf2.12821. Epub 2020 Jun 
      19.