Research LettersAssociation of change in QRS duration with chronic heart failure outcomes
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.
References (8)
- et al.
Significance of QRS complex duration in patients with heart failure
J Am Coll Cardiol
(2005) - et al.
Relation of increasing QRS duration over time and cardiovascular events in outpatients with heart failure
Am J Cardiol
(2019) - et al.
Relationship between QRS duration and left ventricular dyssynchrony in patients with end-stage heart failure
J Cardiovasc Electrophysiol
(2004) - et al.
2022 AHA/ACC/HFSA Guideline for the management of heart failure: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines
Circulation
(2022)