QRS Prolongation in the Prediction of Clinical Cardiac Events in Patients with Acute Heart Failure: Analysis of Data from the Korean Acute Heart Failure Registry

Abstract

Objectives: A prolonged QRS duration has been associated with an unfavorable prognosis in chronic compensated heart failure (HF). However, its predictive value during an admission for acute HF is limited, even in HF with a preserved ejection fraction (EF). The purpose of this study was to evaluate the prognostic utility of the QRS duration in acute HF. Methods: Analyses were performed using data from 1,489 patients with a 2-year follow-up. The patients were selected from the Korean Acute Heart Failure Registry and were divided into three groups according to QRS duration (≤80, 81-119 or ≥120 ms). The all-cause mortality and readmission for HF were assessed. Results: During the study period, 774 primary events occurred (359 deaths and 415 HF). The event frequencies were higher in patients with a prolonged QRS duration. The increased risk associated with the QRS duration was also demonstrated after adjustment for cardiac outcome variables. The prognostic significance of the QRS duration was demonstrated in patients with reduced EF but not in those with a preserved EF. Conclusions: A prolonged QRS duration could be a significant predictor of the 2-year cardiac outcome in patients with acute HF, particularly in those with a reduced EF.

Spectrum of epidemiological and clinical findings in patients with heart failure with preserved ejection fraction stratified by study design: a systematic review

“…It is interesting to note that, when analysed according to EF thresholds of 45–49% vs. 50–54% vs. ≥55% in community‐based studies, the overall mean prevalence of HFpEF (4.4% vs. 2.3% vs. 3.9%, respectively, and HFpEF as a percentage of all HF (43% vs. 53% vs. 73%, respectively) did not display clear trends. Similarly, when comparing HFpEF prevalence based on EF thresholds of 40–44% vs. 45–49% vs. 50–54% in registry studies, no clear trend was identified in HFpEF as a percentage of all HF (41% vs. 36% vs. 47%) …”

Prognostic Implication of Ventricular Conduction Disturbance Pattern in Hospitalized Patients with Acute Heart Failure Syndrome

“…QRS width was related to worse outcomes in previous studies of patients with HF 1)19)20). However, the variables of bundle branch blocks (BBBs) and NICD were not included in the multivariable analysis of these studies.…”

Prognostic Factors in Hospitalization for Heart Failure in Asia

“…Prolonged QRS duration occurs in approximately 20%, with a significant poor predictor of all-cause mortality and rehospitalization, particularly in patients with LV systolic dysfunction RBBB was an independent predictor of in-hospital mortality 26,27 Anemia…”

“…25 The KorHF registry data show that prolonged QRS duration is present in 19.9%, with a significant poor predictor of all-cause mortality and rehospitalization, particularly in those with LV systolic dysfunction. 26 Inconsistent data exist regarding the prognostic role of bundle branch block (BBB) patterns for clinical outcomes in hospitalized patients with HF. Based on KorHF data, right BBB (RBBB) was present in 5.4%, left BBB (LBBB) in 4.9%, and no BBB in 89.7%.…”