QRS micro-fragmentation as a mortality predictor

Katerina Hnatkova, Irena Andršová, Tomáš Novotný, Annie Britton, Martin Shipley, Bert Vandenberk, David J. Sprenkeler, Juhani Junttila, Tobias Reichlin, Simon Schlögl, Marc A. Vos, Tim Friede, Axel Bauer, Heikki V. Huikuri, Rik Willems, Georg Schmidt, Michael R. Franz, Christian Sticherling, Markus Zabel, Marek Malik

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Aims Fragmented QRS complex with visible notching on standard 12-lead electrocardiogram (ECG) is understood to represent depolarization abnormalities and to signify risk of cardiac events. Depolarization abnormalities with similar prognostic implications likely exist beyond visual recognition but no technology is presently suitable for quantification of such invisible ECG abnormalities. We present such a technology. Methods A signal processing method projects all ECG leads of the QRS complex into optimized three perpendicular dimen- and results sions, reconstructs the ECG back from this three-dimensional projection, and quantifies the difference (QRS ‘micro’fragmentation, QRS-μf) between the original and reconstructed signals. QRS ‘micro’-fragmentation was assessed in three different populations: cardiac patients with automatic implantable cardioverter-defibrillators, cardiac patients with severe abnormalities, and general public. The predictive value of QRS-μf for mortality was investigated both univariably and in multivariable comparisons with other risk factors including visible QRS ‘macro’-fragmentation, QRS-Mf. The analysis was made in a total of 7779 subjects of whom 504 have not survived the first 5 years of follow-up. In all three populations, QRS-μf was strongly predictive of survival (P, 0.001 univariably, and P, 0.001 to P = 0.024 in multivariable regression analyses). A similar strong association with outcome was found when dichotomizing QRS-μf prospectively at 3.5%. When QRS-μf was used in multivariable analyses, QRS-Mf and QRS duration lost their predictive value. Conclusion In three populations with different clinical characteristics, QRS-μf was a powerful mortality risk factor independent of several previously established risk indices. Electrophysiologic abnormalities that contribute to increased QRS-μf values are likely responsible for the predictive power of visible QRS-Mf.

Original languageEnglish
Pages (from-to)4177-4191
Number of pages15
JournalEuropean Heart Journal
Issue number40
StatePublished - 21 Oct 2022
Externally publishedYes


  • Electrocardiogram
  • Fragmentation
  • Mortality prediction
  • QRS complex


Dive into the research topics of 'QRS micro-fragmentation as a mortality predictor'. Together they form a unique fingerprint.

Cite this