الفهرس 
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Abstract
Coronary heart disease (CHD) is the leading cause of morbidity and mortality world-wide. Great advances have been made in elucidating the complex mechanistic interactions among risk factors associated with CHD, yielding abundant success towards preventive measures and the development of pharmaceuticals to prevent and treat CHD. However, significant residual risk remains (Shaya et al., 2022).
Fragmented QRS (fQRS) is a depolarization disorder due to a conduction delay caused by myocardial fibrotic tissue that can be easily detected on twelve-lead surface electrocardiography (ECG) (Pietrasik et al., 2012)
Non-invasive imaging methods, including exercise myocardial perfusion SPECT techniques contribute to the diagnosis and risk classification of CAD patients by providing vital details regarding myocardial perfusion and function. However, it was yet unknown if fQRS has the diagnostic capacity to detect myocardial ischemia in patients who may have CAD and lack cardiac scar formation.
The objective of this research was to determine the predictive value of fragmented QRS complex (fQRS) in the diagnosis of myocardial ischemia without scar tissue.
This was observational case-control that was carried out in Cardiology Departments in Benham University Hospitals and Al-Doaa Hospital and had included 206 patients who underwent exercise myocardial perfusion SPECT for testing suspected CAD. Patient were divided into 2 groups, Ischemic group (n=52) and non-ischemic control group (n=154).
All patients were subjected to Complete history taking, clinical examination, echocardiography, laboratory evaluation, exercise myocardial perfusion SPECT for evaluation of suspected CAD and CAG in patients showed myocardial ischemia on SPECT.
We excluded patients with myocardial scarring detected by SPECT. Patient with LVEF of < 50%, Patients with history of percutaneous coronary intervention (PCI).
Our present study demonstrated that the presence of fQRS on 12- lead ECG had a significant association with ischemic heart disease diagnosed by exercise myocardial perfusion SPECT.
fQRS was associated with more extent of coronary artery disease showing higher prevalence among patients with multivessel disease. The presence of fQRS was associated with two times increased risk of myocardial ischemia
Multivariate logistic regression analysis showed that fQRS, was independent predictors of myocardial ischemia without scar tissue with a sensitivity of 42.31.2%, and specificity of 76.62%.
Incremental predictive value of model including diabetes, hypertension, dyslipidemia, smoking, ST-T alterations and fQRS is associated with highly significance of myocardial ischemia detected by MPI.