QRS prolongation on surface ECG and brain natriuretic peptide as indicators of left ventricular systolic dysfunction

Abstract

Objective. To determine whether the combination of prolonged QRS duration and brain natriuretic peptide (BNP) levels predicts left ventricular systolic dysfunction (LVSD) with a higher accuracy compared with QRS duration or BNP alone. Setting. University hospital. Methods. We studied 128 consecutive patients with suspected cardiac disease. At rest the QRS duration on 12-lead ECG and BNP levels were determined. A left ventricular ejection fraction (LVEF) <50% at echocardiography was defined as LVSD. Results. QRS duration in the LVSD group (n ¼ 66, LVEF 30 ± 8%) was longer than in the group without LVSD (n ¼ 62, LVEF 60 ± 5%; QRS 129 ± 34 vs. 96 ± 20 ms, P < 0.001). BNP was higher in the LVSD group compared with controls (467 ± 397 vs. 169 ± 242 pg mL )1 , P < 0.001).A QRS duration of >0.1, >0.11 or >0.12 s was highly specific (63, 90 and 98%) but less sensitive (84, 81 and 75%) for the prediction of LVSD. A QRS cut-off value of 106 ms was moderately sensitive (65%) but very specific (87%) for the prediction of LVSD, whereas a BNP cut-off value of >84 pg mL )1 was highly sensitive (89%) but only modestly specific (58%). The positive likelihood ratio for LVSD of abnormal BNP (2.0) and QRS prolongation >0.1 s (2.3) was improved by the combination of both criteria (5.1). In multivariate analysis, BNP and QRS duration were independent predictors of LVSD.Conclusions. The combination of abnormal BNP and QRS prolongation yields a higher positive likelihood ratio for the detection of LVSD compared with the two criteria alone.

Ruling out heart failure in primary-care: The cost-benefit of pre-screening using NT-proBNP and QRS width

“…We did not find QRS width to be a more specific marker than NT-proBNP for the detection of LVSD (see Fig. 2a) contrary to previous papers [20,21]. This may be due to the modest numbers in our study or those patients with broad QRS due to RBBB and LV pacing but in whom major cardiac disease was absent.…”

“…As was found with NTproBNP, its usefulness to rule-out mild LVSD is limited due to poor test specificity. A similarly low specificity for QRS width was observed by Krüger et al when detecting LVEFb50% [20]. We did not find QRS width to be a more specific marker than NT-proBNP for the detection of LVSD (see Fig.…”

“…A larger improvement was observed by Kruger et al although this was still only modest [20]. However, QRS measurement requires an ECG to be performed in primarycare and this has logistical and cost implications.…”

“…The combination of QRS width and natriuretic peptides may improve the accuracy of diagnosing impaired LV-function in an outpatient HF-clinic setting [20] and in dyspnoeic patients presenting to an emergency department [21].…”

Incremental Changes in QRS Duration Predict Mortality in Patients with Atrial Fibrillation

“…Therefore, QRS duration reflects both electrical and mechanical function of the heart and can be used as a simple prognostic indicator in AF patients. Krüger et al reported that QRS duration and brain natriuretic peptide levels were independent predictors of LV systolic dysfunction in patients with sinus rhythm or AF 24 …”