BACKGROUND: We determined the relationship between fragmented QRS (fQRS) on 
electrocardiograms (ECG) as well as myocardial fibrosis measured by delayed 
enhancement of cardiac magnetic resonance imaging (DE-CMR) and its prognostic 
implication in patients with non-ischemic dilated cardiomyopathy (DCM).
METHODS: The ECGs of 86 subjects with dilated non-ischemic DCM who underwent 
DE-CMR were analyzed. DCM was defined as LV end-diastolic dimension >55 mm with 
LVEF <45% and chronic symptomatic heart failure for ≥ 9 months. Cardiac events 
(re-hospitalization due to heart failure, arrhythmic event, cardiac death) were 
reviewed retrospectively. fQRS was defined by the presence of an additional R 
wave (R"), or notching of the S wave, or the presence of more than one R prime 
in two contiguous leads.
RESULTS: In 86 patients, fQRS developed in 53 patients (61.6%) and delayed 
enhancement was observed in 42 patients (48.8%). The mean ejection fraction was 
25.0%. Baseline characteristics were similar in both groups. Analyses of 
echocardiographic parameters revealed left ventricular end-diastolic and 
end-systolic dimensions were significantly higher in the fQRS group, but that 
the left ventricular ejection fraction was not significantly different. The 
prevalence of delayed enhancement between two groups was not significantly 
different (50.9% in fQRS vs. 45.5% in the non-fQRS group; p=0.62). MACE-free 
survival was significantly decreased in the fQRS group compared with the 
non-fQRS group.
CONCLUSION: There was no spatial relationship between fQRS and DE-CMR in 
patients with non-ischemic DCM. fQRS was associated with lower event-free 
survival for major cardiac events on long-term follow-up.