Association of QRS duration and outcomes after myocardial infarction: the VALIANT trial

Yerra, Lakshminarayan; Anavekar, Nagesh S.; Skali, Hicham; Zelenkofske, Steve; Velázquez, Eric J.; McMurray, John J.V.; Pfeffer, Marc A.; Solomon, Scott D.

doi:10.1016/j.hrthm.2005.11.024

Cited by 53 publications

(43 citation statements)

References 17 publications

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“…QRS duration has been shown to be associated with adverse outcomes in patients with heart failure, 5,6 and decreased survival is more likely after myocardial infarction associated with impaired left ventricular function or heart failure. 4,17 QRS duration is a readily available "front-line" clinical indicator of increased risk of SCD, suggesting consideration of cardiac function assessment or evaluation of coronary artery disease in patients with suspected heart failure in particular.…”

Section: Results In Comparison With Previous Investigationsmentioning

confidence: 99%

Duration of QRS Complex in Resting Electrocardiogram Is a Predictor of Sudden Cardiac Death in Men

et al. 2012

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Background-Previous studies indicate that increased QRS duration in ECG is related to the risk of all-cause death. However, the association of QRS duration with the risk of sudden cardiac death (SCD) is not well documented in large population-based studies. Our aim was to examine the relation of QRS duration with SCD in a population-based sample of men. Methods and Results-This prospective study was based on a cohort of 2049 men aged 42 to 60 years at baseline with a 19-year follow-up, during which a total of 156 SCDs occurred. As a continuous variable, each 10-ms increase in QRS duration was associated with a 27% higher risk for SCD (relative risk, 1.27; 95% confidence interval, 1.14 -1.40; PϽ0.001). Subjects with QRS duration of Ͼ110 ms (highest quintile) had a 2.50-fold risk for SCD (relative risk, 2.50; 95% confidence interval, 1.38 -4.55; Pϭ0.002) compared with those with QRS duration of Ͻ96 ms (lowest quintile), after adjustment for established key demographic and clinical risk factors (age, alcohol consumption, previous myocardial infarction, smoking, serum low-and high-density lipoprotein cholesterol, C-reactive protein, type 2 diabetes mellitus, body mass index, systolic blood pressure, and cardiorespiratory fitness). In addition to QRS duration, smoking, previous myocardial infarction, type 2 diabetes mellitus, cardiorespiratory fitness, body mass index, systolic blood pressure, and C-reactive protein were independently associated with the risk of SCD. Conclusions-QRS duration is an independent predictor of the risk of SCD and may have utility in estimating SCD risk in the general population. (Circulation. 2012;125:2588-2594.)

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Section: Results In Comparison With Previous Investigationsmentioning

confidence: 99%

Duration of QRS Complex in Resting Electrocardiogram Is a Predictor of Sudden Cardiac Death in Men

et al. 2012

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“…The progression of ischemic heart disease, for example, is often associated with alterations of the conduction system causing dyssynchronous contraction, associated with enhancement of local strain 35 and susceptibility to arrhythmias. 36 For example, prolongation of the QRS interval (a measure of LV dyssynchrony) is an independent marker of susceptibility to sudden cardiac death. 36 A mechanoelectrical feedback mechanism for localized VER is expected to amplify heterogeneity of repolarization and susceptibility to arrhythmias under such circumstances.…”

Section: Discussionmentioning

confidence: 99%

“…36 For example, prolongation of the QRS interval (a measure of LV dyssynchrony) is an independent marker of susceptibility to sudden cardiac death. 36 A mechanoelectrical feedback mechanism for localized VER is expected to amplify heterogeneity of repolarization and susceptibility to arrhythmias under such circumstances. This may have direct implications for the mechanism of both deleterious and beneficial remodeling recently recognized with single 7 versus biventricular 8 pacing, respectively.…”

Section: Discussionmentioning

confidence: 99%

Mechanoelectrical Feedback as Novel Mechanism of Cardiac Electrical Remodeling

et al. 2007

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Background-Altered electrical activation of the heart by pacing or disease induces profound ventricular electrical remodeling (VER), manifested electrocardiographically as T-wave memory and ultimately as deleterious mechanical remodeling from heterogeneous strain. Although T-wave memory is associated with altered expression of sarcolemmal ion channels, the biophysical mechanisms responsible for triggering remodeling of cardiac ion channels are unknown. Methods and Results-To test the hypothesis that mechanoelectrical feedback triggered by regional strain is a mechanism for VER, dogs (nϭ6) underwent 4 weeks of ventricular pacing to induce VER. Multisegment transmural optical action potential imaging of left ventricular wedges revealed profound and selective prolongation of action potential duration in late-activated (288Ϯ29 ms) compared with early-activated (250Ϯ9 ms) myocardial segments (PϽ0.05), providing the first experimental evidence that amplification of repolarization gradients between segments of left ventricle is the electrophysiological basis for T-wave memory. In vivo tagged magnetic resonance imaging revealed a 2-fold and preferential increase in circumferential strain in late-activated segments of myocardium, which exactly coincided with segments undergoing VER. VER could not be attributed to structural remodeling because it occurred without any histological evidence of cellular hypertrophy. Conclusions-The mechanism responsible for triggering remodeling of ion channel function in VER was locally enhanced circumferential strain. These data suggest a novel mechanoelectrical feedback mechanism for inducing physiological and potentially deleterious electrical heterogeneities in the heart. (Circulation. 2007;115:3145-3155.)

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“…Standard echocardiographic parameters, including ventricular volumes and ejection fractions, were analyzed with an offline analysis workstation as previously described. [11][12][13][14] Dyssynchrony indexes were measured with B-mode speckle tracking software (velocity vector imaging, Axius VVI 2.0, Siemens Medical Solutions, Malvern, Pa) that circumvents angle dependency and identifies cardiac motion by tracking multiple reference points, inward and outward border motion, motion of tissue along the direction of the border, and periodicity between cardiac cycles. [15][16][17][18][19] After tracing the subendocardium of the left ventricle, the semiautomated tracking algorithm outlined the myocardium from frame to frame throughout the cardiac cycle, and velocity vectors, overlaid onto the B-mode image, were displayed with the direction and relative speed of the tissue.…”

Section: Echocardiographic Analysismentioning

confidence: 99%

Mechanical Dyssynchrony After Myocardial Infarction in Patients With Left Ventricular Dysfunction, Heart Failure, or Both

et al. 2010

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Background-Mechanical dyssynchrony is considered an independent predictor for adverse cardiovascular outcomes in patients with heart failure. However, its importance as a risk factor after myocardial infarction is not well defined. Methods and Results-We examined the influence of mechanical dyssynchrony on outcome in patients with left ventricular dysfunction, heart failure, or both after myocardial infarction who were enrolled in the Valsartan in Acute Myocardial Infarction (VALIANT) echocardiography study. B-mode speckle tracking with velocity vector imaging was used to assess ventricular synchrony in 381 patients who had image quality sufficient for analysis. Time to regional peak velocity and time to strain rate were measured among 12 left ventricular segments from the apical 4-and 2-chamber views, and the SDs between all 12 segments were used as a measure of dyssynchrony. The relationships between the SD of time to regional peak velocity and strain rate and clinical outcome of death or heart failure were assessed. In a multivariate Cox model adjusted for clinical and echocardiographic variables, the SD of time to peak velocity (hazard ratio per 10 ms, 1.10; 95% confidence interval, 1.02 to 1.18; Pϭ0.010) and the SD of time to strain rate (hazard ratio per 10 ms, 1.16; 95% confidence interval, 1.06 to 1.27; Pϭ0.001) were independent predictors of death or heart failure. Conclusion-Left ventricular dyssynchrony is independently associated with increased risk of death or heart failure after myocardial infarction, suggesting that contractile pattern may play a role in post-myocardial infarction prognosis.

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Association of QRS duration and outcomes after myocardial infarction: the VALIANT trial

Cited by 53 publications

References 17 publications

Duration of QRS Complex in Resting Electrocardiogram Is a Predictor of Sudden Cardiac Death in Men

Duration of QRS Complex in Resting Electrocardiogram Is a Predictor of Sudden Cardiac Death in Men

Mechanoelectrical Feedback as Novel Mechanism of Cardiac Electrical Remodeling

Mechanical Dyssynchrony After Myocardial Infarction in Patients With Left Ventricular Dysfunction, Heart Failure, or Both

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