BACKGROUND: Prolongation of the QRS duration has been shown to be associated with adverse outcomes among heart failure (HF) patients. The association of QRS duration with clinical outcomes in the post-myocardial infarction (MI) setting is less well defined. OBJECTIVES: To assess the prognostic significance of QRS duration prolongation on initial electrocardiogram after acute MI. METHODS: QRS duration was measured in 403 patients with MI complicated by left ventricular dysfunction, signs or symptoms of HF, or both, who were enrolled in the Valsartan in Acute Myocardial Infarction (VALIANT) echo study. The cohort was divided into quartiles of QRS duration (<75 ms, 75-88 ms, 89-108 ms, >108 ms). The number of clinical events were determined and compared across the groups. RESULTS: Increasing QRS duration is associated with a higher incidence of HF, sudden death (SD), and cardiovascular (CV) death (P-trend <0.05) but not with stroke or recurrent MI. The univariate relative risks for HF, SD, and CV death with increasing QRS duration quartiles were 1.31 (95% CI, 1.06-1.64), 1.57 (95% CI, 1.03-2.40), and 1.31 (95% CI, 1.03-1.66), respectively, but QRS duration did not remain independently predictive of adverse outcome after adjusting for the 10 most predictive baseline covariates. Baseline end-diastolic and end-systolic volumes were larger and ejection fraction was lower in the higher QRS quartile groups. CONCLUSIONS: Prolonged QRS duration, even within the normal range, is associated with larger ventricular volumes, reduced systolic function, and an increased risk for development of HF, SD, and CV death after MI but appears to be a marker, rather than an independent predictor, for increased risk.
BACKGROUND: Prolongation of the QRS duration has been shown to be associated with adverse outcomes among heart failure (HF) patients. The association of QRS duration with clinical outcomes in the post-myocardial infarction (MI) setting is less well defined. OBJECTIVES: To assess the prognostic significance of QRS duration prolongation on initial electrocardiogram after acute MI. METHODS: QRS duration was measured in 403 patients with MI complicated by left ventricular dysfunction, signs or symptoms of HF, or both, who were enrolled in the Valsartan in Acute Myocardial Infarction (VALIANT) echo study. The cohort was divided into quartiles of QRS duration (<75 ms, 75-88 ms, 89-108 ms, >108 ms). The number of clinical events were determined and compared across the groups. RESULTS: Increasing QRS duration is associated with a higher incidence of HF, sudden death (SD), and cardiovascular (CV) death (P-trend <0.05) but not with stroke or recurrent MI. The univariate relative risks for HF, SD, and CV death with increasing QRS duration quartiles were 1.31 (95% CI, 1.06-1.64), 1.57 (95% CI, 1.03-2.40), and 1.31 (95% CI, 1.03-1.66), respectively, but QRS duration did not remain independently predictive of adverse outcome after adjusting for the 10 most predictive baseline covariates. Baseline end-diastolic and end-systolic volumes were larger and ejection fraction was lower in the higher QRS quartile groups. CONCLUSIONS: Prolonged QRS duration, even within the normal range, is associated with larger ventricular volumes, reduced systolic function, and an increased risk for development of HF, SD, and CV death after MI but appears to be a marker, rather than an independent predictor, for increased risk.
Authors: Nina Hakacova; Katarina Steding; Henrik Engblom; Jane Sjögren; Charles Maynard; Olle Pahlm Journal: Ann Noninvasive Electrocardiol Date: 2010-04 Impact factor: 1.468
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Authors: Darwin Jeyaraj; Xiaoping Wan; Eckhard Ficker; Julian E Stelzer; Isabelle Deschenes; Haiyan Liu; Lance D Wilson; Keith F Decker; Tamer H Said; Mukesh K Jain; Yoram Rudy; David S Rosenbaum Journal: Am J Physiol Heart Circ Physiol Date: 2013-05-24 Impact factor: 4.733
Authors: Daniel A Zlotoff; Malek Z O Hassan; Amna Zafar; Raza M Alvi; Magid Awadalla; Syed S Mahmood; Lili Zhang; Carol L Chen; Stephane Ederhy; Ana Barac; Dahlia Banerji; Maeve Jones-O'Connor; Sean P Murphy; Merna Armanious; Brian J Forrestal; Michael C Kirchberger; Otavio R Coelho-Filho; Muhammad A Rizvi; Gagan Sahni; Anant Mandawat; Carlo G Tocchetti; Sarah Hartmann; Hannah K Gilman; Eduardo Zatarain-Nicolás; Michael Mahmoudi; Dipti Gupta; Ryan Sullivan; Sarju Ganatra; Eric H Yang; Lucie M Heinzerling; Franck Thuny; Leyre Zubiri; Kerry L Reynolds; Justine V Cohen; Alexander R Lyon; John Groarke; Paaladinesh Thavendiranathan; Anju Nohria; Michael G Fradley; Tomas G Neilan Journal: J Immunother Cancer Date: 2021-03 Impact factor: 13.751