| Clinical implications of QRS duration in patients hospitalized with worsening heart failure and reduced left ventricular ejection fraction. | |
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MedLine Citation:
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PMID: 18544725 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: JAMA : the journal of the American Medical Association Volume: 299 ISSN: 1538-3598 ISO Abbreviation: JAMA Publication Date: 2008 Jun |
Date Detail:
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Created Date: 2008-06-11 Completed Date: 2008-06-16 Revised Date: 2008-10-28 |
Medline Journal Info:
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Nlm Unique ID: 7501160 Medline TA: JAMA Country: United States |
Other Details:
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Languages: eng Pagination: 2656-66 Citation Subset: AIM; IM |
Affiliation:
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Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. |
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Cause of Death Electrocardiography Female Heart Failure / mortality, physiopathology*, therapy Heart Rate* Hospitalization* Humans Kaplan-Meiers Estimate Male Middle Aged Randomized Controlled Trials as Topic Retrospective Studies Ventricular Dysfunction, Left / physiopathology* |
| Investigator | |
Investigator/Affiliation:
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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 / |
| Comments/Corrections | |
Comment In:
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JAMA. 2008 Oct 22;300(16):1880; author reply 1880-1
[PMID:
18940972
]
JAMA. 2008 Oct 22;300(16):1879; author reply 1880-1 [PMID: 18940971 ] JAMA. 2008 Oct 22;300(16):1879-80; author reply 1880-1 [PMID: 18940970 ] |
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