الفهرس 
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Abstract
Coronary artery ectasia (CAE) is defined as coronary artery dilatation that is at least 1.5 times larger than the normal adjacent segments or the largest coronary artery diameter. The term ectasia describes diffuse dilatation of the coronary artery, and focal dilatation is termed as coronary aneurysm.
Coronary artery ectasia is primarily caused by atherosclerosis (50% of cases), it mainly occurs secondary to congenital malformations, connective tissue diseases, vasculitic syndromes and collagenopathies and following the coronary artery revascularization procedures.
Fragmented QRS (fQRS) is thought to represent depolarization of the ventricles, which can be determined by an electrocardiogram (ECG) with 12 superficial channels, and it is caused by the slowdown of electrical conduction because of myocardial fibrosis. The slowdown of electrical conduction causes non-homogen ventricular activation, which can be observed in an ECG as notching on the QRS complex.
Fragmented QRS (fQRS), which has attracted great interest as a new, easy to assess, and reliable electrocardiographic (ECG) finding in clinical practice, has been defined as the presence of notched R or S waves without accompanying typical bundle branch block, or the existence of an additional wave resembling an RSR’ pattern in the original QRS complex (with a duration of < 120 ms).
It reflects impaired ventricular depolarization due to heterogeneous electrical activation of ischemic and/or infarcted ventricular myocardium. A narrow fQRS, caused by non-specific electrical deviation and/or deformation of QRS morphology, has recently been associated with a high risk of sudden cardiac death in patients with idiopathic dilated cardiomyopathy.
Furthermore, a wide or narrow fQRS on the admission ECG strongly predicts event-free survival rates in patients with dilated cardiomyopathy and a left ventricular ejection fraction (LVEF) < 40%.
This work aims at studying the relationship between QRS fragmentation on 12-lead electrocardiography and coronary artery ectasia detected by invasive coronary angiography.
This study included 100 patients presented to Damietta Cardiology Center with chest pain referred for invasive coronary angiography. Patients will be divided to 2 groups. The First group (patients) included 50patients with isolated coronary artery ectasia. The second group included 50 healthy subjects with angiographically normal coronaries.
All patients were clinically evaluated, had routine laboratory investigations, 12 leads ECG, transthoracic echocardiography and angigraphy.
By analyzing and processing the data obtained from the history, clinical examination and lab work the study declared that:
We found that 58% of the CAE group were smokers, 58% were diabetic, and 52% hypertensives.
Regarding number of affected ectatic vessels, it was single vessel in 19 patients (38.0%) and multi-vessels in 13 patients (26.0%). The affection was in LM in one subject (2.0%), LAD in 39 subjects (78.0%), LCX in 21 subjects (42.0%) and RCA in 33 subjects (66.0%).
Regarding fQRS, it was reported in 53% of the whole study population with significant increase of fQRS in the CAE group when compared to the normal group (94% vs 12% respectively) and All fQRS in normal group were in inferior leads; while it was in all leads in 16% of the CAE group, in anterior leads in 20%, in inferior leads in 20%, anterior and lateral leads in 8%, anterior and inferior leads in 22%, lateral leads in 4%, anteroseptal leads in 2% and inferior and high lateral leads in 2%; and there was significant difference between CAE and normal groups.
During echocardiographic evaluation, there was a statistically significant increase in diastolic dysfunction in the CAE group when compared to the normal group (54% vs. 34.0% respectively).
Fragmented QRS complex in patients with CAE wasn’t affected by age, sex, smoking, DM, HTN, dyslipidemia, systolic BP, diastolic BP, and family history.
In our study, The fQRS role in diagnosis of ectatic disease revealed sensitivity of 94%, specificity of 88%, PPV of 88.7%, NPF of 93.6% and overall accuracy of 91.0%.