{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T16:35:10Z","timestamp":1791045310348,"version":"4.1.0"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2023,3,21]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Fragmented QRS (fQRS) morphology as a surrogate marker of the possible presence of myocardial scarring has been shown to confer a higher risk in patients with reduced ejection fraction heart failure. We aimed to investigate the pathophysiological correlates and prognostic implications of fQRS in patients with heart failure with preserved ejection fraction (HFpEF).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      We consecutively studied 960 patients with HFpEF (76.4\u00b112.7\u2009years, men: 37.2%). fQRS was assessed using a body surface ECG during hospitalization. QRS morphology was available and classified into 3 categories among 960 subjects with HFpEF as non\u2010fQRS, inferior fQRS, and anterior\/lateral fQRS groups. Despite comparable clinical features in most baseline demographics among the 3 fQRS categories, anterior\/lateral fQRS showed significantly higher B\u2010type natriuretic peptide\/troponin levels (both\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001), with both the inferior and anterior\/lateral fQRS HFpEF groups demonstrating a higher degree of unfavorable cardiac remodeling, greater extent of myocardial perfusion defect, and slower coronary flow phenomenon (all\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.05). Patients with anterior\/lateral fQRS HFpEF exhibited significantly altered cardiac structure\/function and more impaired diastolic indices (all\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.05). During a median of 657\u2009days follow\u2010up, the presence of anterior\/lateral fQRS conferred a doubled HF re\u2010admission risk (adjusted hazard ratio 1.90,\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001), with both inferior and anterior\/lateral fQRS having a higher risk of cardiovascular and all\u2010cause death (all\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.05) by using Cox regression models.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">The presence of fQRS in HFpEF was associated with more extensive myocardial perfusion defects and worsened mechanics, which possibly denotes a more severe involvement of cardiac damage. Early recognition in such patients with HFpEF likely benefits from targeted therapeutic interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.122.028105","type":"journal-article","created":{"date-parts":[[2023,4,27]],"date-time":"2023-04-27T14:21:24Z","timestamp":1682605284000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["QRS Fragmentation in Preserved Ejection Fraction Heart Failure: Functional Insights, Pathological Correlates, and Prognosis"],"prefix":"10.1161","volume":"12","author":[{"given":"Kuo\u2010Tzu","family":"Sung","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Cardiovascular Center and Division of Cardiology MacKay Memorial Hospital Taipei Taiwan (R.O.C)"},{"name":"Mackay Junior College of Medicine, Nursing and Management New Taipei city Taiwan (R.O.C.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheng\u2010Hsiung","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Cardiovascular Center and Division of Cardiology MacKay Memorial Hospital Taipei Taiwan (R.O.C)"},{"name":"Mackay Junior College of Medicine, Nursing and Management New Taipei city Taiwan (R.O.C.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Po\u2010Ching","family":"Chi","sequence":"additional","affiliation":[{"name":"Department of Cardiology Zhongmei Hospital Taoyuan Taiwan (R.O.C.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shih\u2010Chieh","family":"Chien","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Cardiovascular Center and Division of Cardiology MacKay Memorial Hospital Taipei Taiwan (R.O.C)"},{"name":"MacKay Medical College New Taipei City Taiwan (R.O.C.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi\u2010In","family":"Lo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Cardiovascular Center and Division of Cardiology MacKay Memorial Hospital Taipei Taiwan (R.O.C)"},{"name":"MacKay Medical College New Taipei City Taiwan (R.O.C.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao\u2010Feng","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Cardiovascular Center and Division of Cardiology MacKay Memorial Hospital Taipei Taiwan (R.O.C)"},{"name":"MacKay Medical College New Taipei City Taiwan (R.O.C.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen\u2010Hung","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Cardiovascular Center and Division of Cardiology MacKay Memorial Hospital Taipei Taiwan (R.O.C)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2463-1726","authenticated-orcid":false,"given":"Chun\u2010Ho","family":"Yun","sequence":"additional","affiliation":[{"name":"Division of Radiology MacKay Memorial Hospital Taipei Taiwan (R.O.C.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7958-1394","authenticated-orcid":false,"given":"Cheng\u2010Ting","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Cardiovascular Center and Division of Cardiology MacKay Memorial Hospital Taipei Taiwan (R.O.C)"},{"name":"MacKay Medical College New Taipei City Taiwan (R.O.C.)"},{"name":"Mackay Junior College of Medicine, Nursing and Management New Taipei city Taiwan (R.O.C.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng\u2010Huang","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Cardiovascular Center and Division of Cardiology MacKay Memorial Hospital Taipei Taiwan (R.O.C)"},{"name":"MacKay Medical College New Taipei City Taiwan (R.O.C.)"},{"name":"Mackay Junior College of Medicine, Nursing and Management New Taipei city Taiwan (R.O.C.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6602-5532","authenticated-orcid":false,"given":"Charles Jia\u2010Yin","family":"Hou","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Cardiovascular Center and Division of Cardiology MacKay Memorial Hospital Taipei Taiwan (R.O.C)"},{"name":"MacKay Medical College New Taipei City Taiwan (R.O.C.)"},{"name":"Mackay Junior College of Medicine, Nursing and Management New Taipei city Taiwan 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