Electroanatomic Ratios and Mortality in Patients With Heart Failure: Insights from the ASIAN‐HF Registry

Abstract

Background QRS duration (QRSd) is a marker of electrical remodeling in heart failure. Anthropometrics and left ventricular size may influence QRSd and, in turn, may influence the association between QRSd and heart failure outcomes. Methods and Results Using the prospective, multicenter, multinational ASIAN‐HF (Asian Sudden Cardiac Death in Heart Failure) registry, this study evaluated whether electroanatomic ratios (QRSd indexed for height or left ventricular end‐diastole volume) are associated with 1‐year mortality in individuals with heart failure with reduced ejection fraction. The study included 4899 individuals (aged 60±19 years, 78% male, mean left ventricular ejection fraction: 27.3±7.1%). In the overall cohort, QRSd was not associated with all‐cause mortality (hazard ratio [HR], 1.003; 95% CI, 0.999–1.006, P =0.142) or sudden cardiac death (HR, 1.006; 95% CI, 1.000–1.013, P =0.059). QRS/height was associated with all‐cause mortality (HR, 1.165; 95% CI, 1.046–1.296, P =0.005 with interaction by sex p interaction =0.020) and sudden cardiac death (HR, 1.270; 95% CI, 1.021–1.580, P =0.032). QRS/left ventricular end‐diastole volume was associated with all‐cause mortality (HR, 1.22; 95% CI, 1.05–1.43, P =0.011) and sudden cardiac death (HR, 1.461; 95% CI, 1.090–1.957, P =0.011) in patients with nonischemic cardiomyopathy but not in patients with ischemic cardiomyopathy (all‐cause mortality: HR, 0.94; 95% CI, 0.79–1.11, P =0.467; sudden cardiac death: HR, 0.734; 95% CI, 0.477–1.132, P =0.162). Conclusions Electroanatomic ratios of QRSd indexed for body size or left ventricular size are associated with mortality in individuals with heart failure with reduced ejection fraction. In particular, increased QRS/height may be a marker of high risk in individuals with heart failure with reduced ejection fraction, and QRS/left ventricular end‐diastole volume may further risk stratify individuals with nonischemic heart failure with reduced ejection fraction. Registration URL: https://Clinicaltrials.gov . Unique identifier: NCT01633398.

Postoperative QRS duration to left ventricular end-diastolic diameter ratio as a predictor for the risk of postoperative atrial fibrillation in cardiac surgery: A single-center prospective study

“…We didn't find postoperative LVEDD has a significant difference between these patients (47.06 ± 6.85 vs 49.02 ± 7.46 mm, p = 0.101). Differences in left ventricular size is postulated to contribute to variations of QRS with sex, race and obesity [ 20 ]. QRS duration can be normalized to left ventricular dimension to adjust for ventricular conduction path length, result in a measure of conduction velocity of myocardial [ 14 ].…”

“…Subgroup analyses showed that QRS/LVEDD was stable in each subgroup, which indicated that QRS/LVEDD was a predictor which would not influence by gender, aging, BMI or types of surgery. In previously studies, Chyou JY et al has found that indexing of QRS to LVEDV can predict mortality in patients with heart failure with preserved ejection fraction (HFrEF) with nonischemic cardiomyopathy [ 20 ], and strongly correlated with cardiac resynchronization therapy [ 14 ]. The mechanism underlying is complex and multifactorial, with several potential pathway implicated.…”

Electrocardiographic frontal QRS-T angle is independently associated with panic disorder

“…Increased electrocardiographic QRSd is a marker of myocardial/ electrical remodeling, structural changes and increased TDR in the myocardium. 8 Recent studies have shown that structural changes in the myocardium, including myocyte hypertrophy and fibrosis, occur simultaneously in the atria and ventricles. Therefore, an increased QRS duration is considered indicative of ventricular and supraventricular arrhythmias.…”