Fragmented QRS complex could predict all-cause mortality in patients with connective tissue disease–associated pulmonary arterial hypertension

Abstract

Abstract Objectives To investigate the prognostic impact and pathophysiological characteristics of fragmented QRS complex (fQRS) on patients with CTD-associated pulmonary arterial hypertension (CTD-PAH). Methods This was a multicentre retrospective study recruiting 141 patients with CTD-PAH diagnosed by right heart catheterization (114 cases in the discovery cohort and 27 cases in the validation cohort). fQRS and ST-T change were detected on conventional 12-lead ECG. Patients were followed up every 3 months to update their status and the primary endpoint was all-cause death. Clinical information and ECG characteristics were compared between survival and death groups and Kaplan–Meier curve was used for survival analysis. Results There were significant differences in age, gender, 6-min walk distance, N-terminal pro-brain natriuretic peptide, World Health Organization class, presence of fQRS, and presence of ST-T change in inferior leads between survival group and death group. Inferior fQRS and ST-T change were significantly associated with right ventricular dilatation and reduced right ventricular ejection fraction. Kaplan–Meier curve showed that all-cause mortality was higher in CTD-PAH with fQRS (P = 0.003) and inferior ST-T change (P = 0.012). Low- and intermediate-risk CTD-PAH with inferior ST-T change had higher all-cause mortality (P = 0.005). The prognostic value of fQRS and inferior ST-T change was validated in external validation cohort. Conclusion The presence of inferior fQRS and ST-T change could predict poor prognosis in CTD-PAH. Clinical trial registration NCT05980728, https://clinicaltrials.gov.