Elsevier

American Heart Journal

Volume 254, December 2022, Pages 77-80
American Heart Journal

Research Letters
Association of change in QRS duration with chronic heart failure outcomes

https://doi.org/10.1016/j.ahj.2022.08.005Get rights and content

Abstract

QRS duration is an established risk factor among patients with heart failure. How change in QRS duration relates to heart failure outcomes has had limited study. In this post-hoc analysis of the Beta-Blocker Evaluation of Survival Trial, we demonstrated that QRS duration change from baseline to 3 months is independently associated with long-term survival and left ventricle ejection fraction.

Section snippets

Methods

Under a data use agreement from BioLINCC, we accessed the trial dataset from the Beta-Blocker Evaluation of Survival Trial (BEST) trial for this analysis. Full details of the enrollment and randomization procedures have been published previously.6 Briefly, the BEST trial was a randomized controlled trial testing the hypothesis that bucindolol would improve survival among patients with heart failure. The trial enrolled patients with New York Heart Association (NYHA) Class III or IV heart failure

Results

The BEST trial dataset contains data for 2,707 subjects. Of these, 233 were excluded for not having ECG data at both baseline and 3 months, and 137 were excluded for having a paced rhythm at either baseline or 3 months. After exclusions, we had 2,337 subjects available for analysis. Survival data was available in 2,305 subjects (Supplemental Figure 1).

Baseline characteristics stratified by QRS change at 3 months are reported in Table I. Overall, the mean age of the cohort is about 60 years old,

Discussion

In this post-hoc study of the BEST trial, we evaluated the relationship between changes in QRS from baseline to 3 months and heart failure outcomes. We found that changes in QRS duration are not rare, with 5.6% of participants experiencing a shortening and 9.2% of participants experiencing a lengthening. We demonstrated that changes in QRS duration at 3 months are independently associated with survival; with an 8% increased hazard of mortality for each 10 msec lengthening of the QRS. Change in

Conclusions

We demonstrated that changes in QRS duration at 3 months are independently associated with long-term survival and future LVEF. ECG is a widely available, inexpensive tool, and our study highlights added utility in prognosticating patients with chronic heart failure. Further studies evaluating the mechanisms underlying QRS change and its association with heart failure outcomes are warranted.

Funding

None.

Conflict of interest

None reported.

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