Relationship between fragmented QRS and serum fibroblast growth factor-23 in hypertensive patients with left ventricular hypertrophy

IF 1.5 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology Pub Date : 2026-05-01 Epub Date: 2026-05-20 DOI:10.1016/j.jelectrocard.2026.154365

Berkant Bebek MD , Alpaslan Karabulut MD , Barış Eser MD , Abdullah Sarıhan MD , Abdülmelik Birgün MD , Muharrem Özden MD , Mucahit Yetim MD , Macit Kalçık MD , Lütfü Bekar MD , Burak Biter MD

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Abstract

Background

Hypertensive heart disease is frequently accompanied by left ventricular hypertrophy (LVH) and myocardial fibrosis, which contribute to diastolic dysfunction and adverse cardiovascular outcomes. Fragmented QRS (fQRS) on surface electrocardiography has been associated with myocardial fibrosis and is considered a potential noninvasive marker of myocardial fibrosis. Fibroblast growth factor-23 (FGF-23), a key regulator of mineral metabolism, has been implicated in myocardial remodeling and fibrosis; however, its relationship with fQRS in hypertensive patients with LVH has not been fully elucidated.

Methods

In this cross-sectional, single-center study, 265 patients with isolated hypertension and echocardiographically confirmed LVH were enrolled. All participants underwent clinical evaluation, laboratory testing, transthoracic echocardiography, and 12‑lead electrocardiography. Serum FGF-23 levels were measured using a sandwich enzyme-linked immunosorbent assay. Patients were compared according to the presence or absence of fQRS. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the discriminative ability of FGF-23 and left ventricular mass index (LVMI) for predicting fQRS.

Results

Fragmented QRS was present in 55 patients (20.8%). Patients with fQRS had significantly higher serum FGF-23 levels compared with those without fQRS (835.1 ± 153.4 vs. 670.7 ± 223.7 pg/mL, p < 0.001). The fQRS-positive group also exhibited higher LVMI and a lower E/A ratio, indicating impaired diastolic function (all p < 0.01). ROC analysis demonstrated that FGF-23 had a moderate ability to predict the presence of fQRS (AUC = 0.734, 95% CI: 0.661–0.808), exceeding that of LVMI (AUC = 0.654, 95% CI: 0.574–0.735).

Conclusions

In hypertensive patients with LVH, the presence of fQRS is associated with elevated serum FGF-23 levels, increased LVMI, and impaired diastolic function. These findings suggest a potential link between FGF-23–related pathways and possible myocardial fibrotic remodeling, and support the complementary value of FGF-23 alongside electrocardiographic markers in risk stratification.

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高血压左室肥厚患者碎片化QRS与血清成纤维细胞生长因子-23的关系

背景：高血压性心脏病常伴有左心室肥厚（LVH）和心肌纤维化，可导致舒张功能障碍和不良心血管结局。表面心电图上的碎片化QRS （fQRS）与心肌纤维化有关，被认为是心肌纤维化的潜在非侵入性标志物。成纤维细胞生长因子-23 （FGF-23）是矿物质代谢的关键调节因子，与心肌重塑和纤维化有关；然而，其与LVH合并高血压患者fQRS的关系尚未完全阐明。方法在这项横断面、单中心研究中，265例超声心动图证实的孤立性高血压患者入组。所有参与者都进行了临床评估、实验室检查、经胸超声心动图和12导联心电图。采用夹心酶联免疫吸附法测定血清FGF-23水平。根据fQRS是否存在进行比较。采用受试者工作特征（ROC）曲线分析，评价FGF-23和左心室质量指数（LVMI）预测fQRS的判别能力。结果55例（20.8%）患者存在碎片化QRS。fQRS患者血清FGF-23水平明显高于无fQRS患者（835.1±153.4 vs. 670.7±223.7 pg/mL, p < 0.001）。fqrs阳性组LVMI升高，E/ a比降低，提示舒张功能受损（p < 0.01）。ROC分析显示，FGF-23预测fQRS存在的能力中等（AUC = 0.734, 95% CI: 0.661-0.808），超过LVMI （AUC = 0.654, 95% CI: 0.574-0.735）。结论在伴有LVH的高血压患者中，fQRS的存在与血清FGF-23水平升高、LVMI增加、舒张功能受损相关。这些发现表明FGF-23相关通路与可能的心肌纤维化重塑之间存在潜在联系，并支持FGF-23与心电图标志物在危险分层中的互补价值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of electrocardiology 医学-心血管系统

CiteScore

2.70

自引率

7.70%

发文量

152

审稿时长

38 days

期刊介绍： The Journal of Electrocardiology is devoted exclusively to clinical and experimental studies of the electrical activities of the heart. It seeks to contribute significantly to the accuracy of diagnosis and prognosis and the effective treatment, prevention, or delay of heart disease. Editorial contents include electrocardiography, vectorcardiography, arrhythmias, membrane action potential, cardiac pacing, monitoring defibrillation, instrumentation, drug effects, and computer applications.