Assessment of fragmented QRS formation and its relationship with left ventricular hypertrophy in nonhypertensive acromegaly patients

Authors: Muhammet DURAL, GÖKNUR YORULMAZ, ELİF SEVİL ALAGÜNEY, KADİR UĞUR MERT, EZGİ ÇAMLI, AHMET TOYGAR KALKAN, AYSEN AKALIN, MEDİNE NUR KEBAPÇI, AHMET SERDAR YILMAZ, SELDA MURAT, FATMA BELGİN EFE

Abstract: Background/aim: It is known that the presence of fragmented QRS (fQRS) on electrocardiography (ECG) is associated with cardiovascular events. The aim of this study was the evaluation of fQRS formation and its relationship with the left ventricular hypertrophy (LVH) parameters in acromegaly patients. Materials and methods: In total, 47 previously diagnosed with non-hypertensive acromegaly patients and 48 control subjects were included in the study. ECG and transthoracic echocardiography (TTE) were performed for each participant. Acromegaly patients were divided into two groups according to the fQRS formation on the ECG. Left ventricular wall thicknesses, and left atrial diameter (LAD), left ventricular mass (LVM), left ventricular mass index (LVMi), and relative wall thickness (RWT) were obtained. Results: In control group 5 (10.4%) and in acromegaly group 17 (36.2%) patients had fQRS on ECG (p = 0.003). LAD [36.0 (34.0-38.0) vs. 38.0 (35.0-41.0) mm, p < 0.001], LVM [155.27 ± 27.00 vs. 173.0 (153.0-235.0) g, p < 0.001], LVMi [83.12 ± 13.19 vs. 92.0 (83.0-118.0) g/m², p < 0.001] and RWT [0.39 ± 0.03 vs. 0.43 (0.41-0.45), p = 0.001] were significantly higher in patients with acromegaly. Disease duration was significantly higher (11.59 ± 1.3 vs. 8.2 ± 1.8 years, p < 0.001) in the fQRS (+) group. LAD [41.0 (39.0-42.5) vs. 37.0 (34.7- 38.0) mm, p < 0.001], LVM [219.0 (160.5-254.5) vs. 164.0 (153.0-188.0) g, p = 0.017], LVMi [117.0 (92.5-128.5) vs. 86.0 (82.0-100.2) g/m², p = 0.013] and RWT [0.44 (0.42-0.49) vs. 0.43 (0.40-0.44), p = 0.037] were significantly higher in fQSR (+) acromegaly patients. In multivariate logistic regression analysis, disease duration (odds ratio: 10.05, 95% CI: 1.099-92.012, p = 0.041) and LAD (odds ratio: 2.19, 95% CI: 1.030-4.660, p = 0.042) were found to be the independent predictors of fQRS formation. Conclusion: The results of our study revealed that fQRS (+) acromegaly patients had increased LVH parameters compared to fQRS (-) patients.

Keywords: Acromegaly, fragmented QRS, left ventricular hypertrophy, left ventricular mass

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