Document Detail

Clinical implications of QRS duration in patients hospitalized with worsening heart failure and reduced left ventricular ejection fraction.
MedLine Citation:
PMID:  18544725     Owner:  NLM     Status:  MEDLINE    
CONTEXT: Hospitalization for heart failure is associated with high postdischarge mortality and morbidity. The predictive value of the QRS duration during admission for heart failure has not been well studied.
OBJECTIVE: To investigate the predictive value of the QRS duration in patients hospitalized for heart failure with reduced left ventricular ejection fraction (LVEF).
DESIGN, SETTING, AND PARTICIPANTS: Retrospective, post hoc analysis from the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan (EVEREST), an event-driven, randomized, double-blind, placebo-controlled study in patients hospitalized for heart failure and having an LVEF of 40% or less. A total of 4133 patients were enrolled at 359 North American, South American, and European sites between October 7, 2003, and February 3, 2006. After excluding 1029 patients with a pacemaker, implantable cardioverter-defibrillator, or both at enrollment and 142 patients without a reported baseline QRS duration, 2962 patients were included in the analysis: 1641 had a normal QRS duration (< 120 ms) and 1321 had a prolonged QRS duration (> or = 120 ms).
MAIN OUTCOME MEASURES: Dual primary end points were all-cause mortality and the composite of cardiovascular death or hospitalization for heart failure.
RESULTS: During a median follow-up of 9.9 months, all-cause mortality was 18.7% for patients with a normal baseline QRS duration and 28.1% for patients with a prolonged baseline QRS duration (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.38-1.87). The composite of cardiovascular death or hospitalization for heart failure was 32.4% for patients with a baseline QRS duration less than 120 ms and 41.6% for patients with a baseline QRS duration of 120 ms or greater (HR, 1.40; 95% CI, 1.24-1.58). The increased risk associated with prolonged QRS duration was confirmed after adjusting for multiple variables for all-cause mortality (HR, 1.24; 95% CI, 1.02-1.50) and the composite of cardiovascular death or hospitalization for heart failure (HR, 1.28; 95% CI, 1.10-1.49). Only 105 patients (3.6%) who presented with a prolonged baseline QRS duration had a normal QRS duration on their last inpatient electrocardiogram.
CONCLUSION: A prolonged QRS duration appears common in patients with reduced LVEF who are hospitalized for heart failure and is an independent predictor of high postdischarge morbidity and mortality.
Norman C Wang; Aldo P Maggioni; Marvin A Konstam; Faiez Zannad; Holly B Krasa; John C Burnett; Liliana Grinfeld; Karl Swedberg; James E Udelson; Thomas Cook; Brian Traver; Christopher Zimmer; Cesare Orlandi; Mihai Gheorghiade;
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  JAMA     Volume:  299     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-06-11     Completed Date:  2008-06-16     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2656-66     Citation Subset:  AIM; IM    
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MeSH Terms
Cause of Death
Heart Failure / mortality,  physiopathology*,  therapy
Heart Rate*
Kaplan-Meier Estimate
Middle Aged
Randomized Controlled Trials as Topic
Retrospective Studies
Ventricular Dysfunction, Left / physiopathology*
A Miller / ; C O'Connor / ; M C Bahit / ; P Carson / ; M Haass / ; R Patten / ; P Hauptman / ; I Pena / ; M Metra / ; R Oren / ; S Roth / ; J Sackner-Bernstein /
Comment In:
JAMA. 2008 Oct 22;300(16):1880; author reply 1880-1   [PMID:  18940972 ]
JAMA. 2008 Oct 22;300(16):1879-80; author reply 1880-1   [PMID:  18940970 ]
JAMA. 2008 Oct 22;300(16):1879; author reply 1880-1   [PMID:  18940971 ]

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