Fragmented QRS Complex in Electrocardiogram as a Predictor for Diastolic Dysfunction in Type 2 Diabetes Mellitus

Abstract

Background: Diabetes mellitus is an escalating public health concern, with the World Health Organization projecting it to be the seventh leading cause of death by 2030. Diastolic dysfunction, an early indicator of heart failure with preserved ejection fraction (HFpEF), is commonly observed in individuals with diabetes. Objective: To examine the association between the fragmented QRS (fQRS) complex on electrocardiography (ECG) and diastolic dysfunction, as identified by 2D echocardiography, in patients with type 2 diabetes mellitus (T2DM). Methods: This hospital-based, cross-sectional study was conducted over two years at Aarupadai Veedu Medical College & Hospital and included 193 T2DM patients aged 18 years and older. Patients with bundle branch blocks, coronary artery disease, decompensated chronic liver disease, and arrhythmias were excluded from the study. Participants underwent ECG to identify the presence of fQRS complexes and 2D echocardiography to assess diastolic function. Results: The mean age of participants was 54.4 ± 10 years, with a slight predominance of females (55.4% female, 44.6% male). An fQRS complex was observed in 45.1% of patients, and 39.4% exhibited diastolic dysfunction on 2D echocardiography. A significant association was found between the presence of fQRS and diastolic dysfunction (p < 0.05). The diagnostic performance of fQRS showed a sensitivity of 96.05%, specificity of 88.03%, positive predictive value (PPV) of 83.91%, negative predictive value (NPV) of 97.17%, and an overall accuracy of 91.19%. Conclusion: The presence of an fQRS complex on ECG is a highly sensitive and specific marker for diastolic dysfunction in T2DM patients, suggesting its potential as a viable alternative to 2D echocardiography, especially in settings with limited resources.