Inflammatory changes in the myocardium create the prerequisites for the electrical instability of the myocardium, which can affect the ECG. It is promising to study relatively new electrocardiographic patterns: fragmentation of QRS (FQRS) and premature ventricular beats (FPVB) and early repolarization pattern (ERP) to improve the screening of patients with suspected myocarditis. Aim. To study FQRS, FPVB and ERP in patients with inflammatory changes in the myocardium. Material and methods. The study included 46 patients (78.3% male, 21.7% women) with suspected myocarditis. Age: median 47.5, quartile 37; 56.5. In all patients, the anamnesis, results of ECG, echocardiography, cardiac magnetic resonance imaging and endomyocardial biopsy were analyzed. Results. The patients were divided into three groups: the 1st – 20 patients with inflammatory and fibrotic changes in the myocardium, the 2nd – 20 patients with myocardial fibrosis without inflammatory, the 3rd – 6 patients without structural changes in the myocardium. FQRS in the 1st group was detected in 35% of the examined, in the 2nd – in 25%, in the 3rd – not registered. FPVB in the 1st group was determined in 55% of the examined, in the 2nd – in 30%, in the 3rd – in 33.3%. ERP in the 1st group was registered in 30% of the examined, in the 2nd group it was not detected, in the 3rd group – in 16.7%. FPVB and ERP were informative for the detection of inflammation (sensitivity – 57.9 and 85% respectively, specificity – 69.2 and 53.8% respectively). For the detection of fibrosis, FPVB proved to be the most informative (sensitivity – 80.0%, specificity – 59.1%). Conclusions. FQRS, FPVB, and ERP are significant ECG-markers for detecting both inflammatory changes in the myocardium and fibrosis. The use of these ECG-markers in routine clinical practice may have an impact on further management of patients with suspected myocarditis.

Aim. To study the relationship between a decrease in left ventricular (LV) ejection fraction (EF) and conventional electrocardiographic (ECG) signs associated with myocardial structure changes (pathological Q wave, ventricular arrhythmias), and relatively novel and less studied (fragmented QRS (fQRS), early ventricular repolarization (EVR)) and to evaluate their significance for identifying patients with mildly-reduced EF (mrEF).Material and methods. The study included 148 patients who were treated and examined at the Almazov National Medical Research Center. During the ECG analysis, fQRS, EVR, pathological Q wave, and ventricular arrhythmias (VAs) were assessed. Echocardiography data were analyzed. Statistical processing was carried out, including Fisher and chi-squared test, as well as correlation and ROC analysis.Results. Depending on the EF level, patients were divided into three groups: group 1 — patients with reduced EF (rEF) (<40%); group 2 — patients with mrEF (40-49%); group 3 — patients with preserved EF (pEF) (>50%). In the 1st group (with rEF), fQRS was registered in 16 (51,6%) patients, in the 2nd (with mrEF) — in 13 (44,8%), in the 3rd (with EF >50%) — in 16 (18,2%). Pathological Q wave was detected in the 1st group (rEF) in 20 (65%) patients, in the 2nd (mrEF) — in 10 (35%); in the 3rd (pEF) — in 15 (18%) (p<0,001). ROC analysis found that fQRS is more important for identifying patients with mrEF. In the 1st group (rEF), EVR was registered in 2 (6,5%) patients, in the 2nd (pEF) — in 2 (6,9%), in the 3rd (EF>50%) — in 11 (12,5%); the differences were not significant (p=0,5). The relationship of EVR, the number of PVCs and the presence of ventricular tachycardia with EF was not revealed.Conclusion. FQRS is significantly more often observed with a decrease in EF and may be a marker of an mildly-reduced EF. There were no significant correlations between EVR and EF. There was also no relationship between VAs and LV systolic dysfunction.

Aim– to analyze the relationship between fQRS and myocardial fibrosis in CAD patients using SPECT. Material and methods.Retrospectively, we have analyzed the anamnesis and examinations of 116 patients with suspected coronary heart disease. The fQRS was assessed according to the criteria of Das M. et al., 2006, along with the presence of a pathological Q wave and a slow increase in the amplitude of the R wave. We analysed the transient myocardial ischemia and/or myocardial scarring using stress/rest SPECT with technetium-99m. Results.fQRS was significantly more frequently detected in patients with stable and partially reversible perfusion defects – 44.1% and 52.2%, respectively, versus 13.0% and 5.5% in patients without perfusion defects or with reversible perfusion defects, p 0.05. Among 28 patients with QRS fragmentation and myocardial fibrosis, 19 (67.8%) had classical signs of fibrosis on the ECG, 9 (32.1%) had no ECG-registered fibrosis but fQRS was detected. The sensitivity of fQRS marker in detecting myocardial fibrosis reached 84.4%, the specificity was 63.3%. Conclusion.fQRS complex is an informative marker for detecting myocardial scarring in patients with coronary artery disease. Analysis of fQRS in daily clinical practice may increase the diagnostic value of electrocardiography in the detection of fibrosis.

PurposeTo study the early repolarization pattern (ERP) in patient with nonischemic cardiomyopathies (acute myocarditis and arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C)).Materials and methods: We analyzed 2 groups of patients: The 1st group — 29 patients with acute myocarditis (21 male, age 48,7±13,5); the 2nd — 51 patients with confirmed diagnose of ARVD/C (27 male, age 33±7). We used the criteria by Macfarlane P.W. et al., 2015 to identify ERP. Also we analyzed the results of endomiocardial biopsy (EMB).Results:In the 1st group ERP was detected in 13,8% (4) patients), in the 2nd ERP was detected in 17,6% (9) patients. There was no significant difference between frequency of ERP in these groups (p>0.05In the 1st group in all patients was detected inflammation by EMB, myocardial fibrosis was found in 25% (1) patients. In the 2nd group in 22,2% (2) patients with ERP there were no structural abnormalities detected by EMB, and other 78% patients had residual myocytes.Conclusions.On the example of myocarditis and ARVD/C we demonstrated that the ERP was not studied for all diseases that have a pathogenetic basis for its occurrence. Further prospective studies are necessary to evaluate the relationship with the arrhythmias, including malignant ones.

Aim. To investigate on the QRS complex fragmentation (fQRS) in patients with idiopathic ventricular arrhythmias (VA) .Material and methods. Totally, 125 patients, selected into 2 groups: 1st group — 100 patients (mean age 46,4±14,1 y., 69 females) with idiopathic VRD. Patients had predominating daytime arrhythmia (63%), more oftenly — monomorphic ventricular exstrasystolic complexes (VE) (59%), in 39% patients — paroxysms of nonsustained ventricular tachicardia. Structural pathology of myocardium was ruled out based on electrocardiography data, echocardiography, in some cases — magnetic resonance. Second, control group — 25 pts. (69,0±11 y. o., 12 females) with VRD of ischemic origin (coronary heart disease, myocardial infarction in anamnesis). In this group, polymorphic (84%) daytime (68%) VE predominated, and in 25% — nonsustained ventricular tachicardia. Analysis was done with Holter ECG in 12 leads (“KTResult 2”, “Inkart” JSC).Results. In the 1st group, fQRS of sinus complexes was registered in 2 patients (2%) and was transient. Relations in 24-hour dynamics of fQRS were not found. FQRS in VE was registered in 25 patients (25%). One patient had fQRS of sinus complexes as well as fQRS in VE. In 17 patients (68%) fQRS was found in VE. In controls, fQRS of sinus complexes was found in 6 patients (24%), fQRS of VE — in 23 (92%) and was permanent.Conclusion. The phenomenon of fQRS can be found during routine instrumental investigation (standard ECG or Holter ECG), and is more common for CHD patients, being significant criteria for repolarization processes evaluation. Looking for fQRS in patients with idiopathic VRD, probably, is related to dysbalance of autonomous nervous regulation that leads to electrical instability of myocardium. It cannot be ruled out that fQRS might be an early marker of cardiomyopathies. It is necessary to investigate on this phenomenon further and to find its place in risk stratification of sudden cardiac death of patients with no structural heart pathology.