Background
The prolongation of QRS interval has been associated with increased mortality in acute coronary syndrome or chronic stable heart failure (HF). However, the predictive value of QRS duration during an admission for acute decompensated HF (ADHF) is limited and inconsistent. Thus, this study was designed to evaluate the prognostic utility of QRS duration in patients presenting with ADHF.
Methods
Our final analyses were performed from 1,677 (52.4%) patients with fulfillment for the 2-year follow-up from 3,200 hospitalization patients in the Korean acute Heart Failure (KorHF) Registry. A prolonged QRS duration (��� 120ms) on admission was confirmed, and primary cardiac events were assessed in the entire cohort; the 2-year outcomes were defined as death or readmission for HF.
Results
On admission, 353 patients (21.0%) had a prolonged QRS duration, which was associated with male sex, lower ejection fraction, lower systolic and diastolic blood pressure. They were more likely to receive inotropic agents (29.6 vs. 21.6%, p = 0.002) and less likely to receive beta-blockers (33.4 vs. 40.7%, p = 0.014). During follow-up, a total of 887 primary events (52.9%) occurred including 424 deaths and 463 HFs. The frequency of primary events was significantly higher in patients with prolonged QRS duration than in those with normal QRS (61.5 vs. 50.6%, p < 0.001; HR 1.33, 95% CI 1.14 to 1.55, p < 0.001). The increased risk associated with QRS duration was also shown after adjustment for significant variables for cardiac outcomes (HR 1.46, 95% CI 1.13 to 1.88, p = 0.004).
Conclusions
A prolonged QRS duration is a significant predictor of the 2-year cardiac outcomes in patients with ADHF, independent of other clinical and laboratory variables.