Jane A Cannon1, Timothy J Collier2, Li Shen1, Karl Swedberg3, Henry Krum4, Dirk J Van Veldhuisen5, John Vincent6, Stuart J Pocock2, Bertram Pitt7, Faiez Zannad8, John J V McMurray1. 1. BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK. 2. London School of Hygiene & Tropical Medicine, London, UK. 3. University of Gothenburg, Gothenburg, Sweden. 4. Monash University, Melbourne, Australia. 5. University Medical Centre Groningen, The Netherlands. 6. Pfizer Pharma, NY, USA. 7. University of Michigan, MI, USA. 8. Nancy Université, Nancy, France Inserm, Université de Lorraine and CHU de Nancy, Nancy, France.
Abstract
AIMS: We examined the relationship between different degrees of QRS prolongation and different QRS morphologies and clinical outcomes in patients with heart failure, reduced ejection fraction (HF-REF), and mild symptoms in the Eplerenone in Mild Patients Hospitalization and SurvIval Study in Heart Failure trial (EMPHASIS-HF). We also evaluated the effect of eplerenone in these patients according to QRS duration/morphology. METHODS AND RESULTS: Patients were categorized as: QRS duration (ms) (i) <120 (n = 1375); (ii) 120-149 (n = 517); and (iii) ≥150 (n = 383), and QRS morphology (i) normal (n = 1252); (ii) left bundle branch block (BBB) (n = 608); and (iii) right BBB/intraventricular conduction defect (IVCD) (n = 415). The outcomes examined were the composite of cardiovascular death or heart failure hospitalization and all-cause mortality. Both abnormal QRS duration and QRS morphology were associated with higher risk, e.g. the rates of the composite outcome were: 10.2, 17.6, and 15.5 per 100 patient-years in the <120, 120-149, and ≥150 ms groups, respectively. Eplerenone reduced the risk of the primary outcome and mortality, compared with placebo, consistently across the QRS duration/morphology subgroups. CONCLUSION: We found that even moderate prolongation of QRS duration and right BBB/IVCD were associated with a high risk of adverse outcomes in HF-REF. Eplerenone was similarly effective, irrespective of QRS duration/morphology.
AIMS: We examined the relationship between different degrees of QRS prolongation and different QRS morphologies and clinical outcomes in patients with heart failure, reduced ejection fraction (HF-REF), and mild symptoms in the Eplerenone in Mild Patients Hospitalization and SurvIval Study in Heart Failure trial (EMPHASIS-HF). We also evaluated the effect of eplerenone in these patients according to QRS duration/morphology. METHODS AND RESULTS:Patients were categorized as: QRS duration (ms) (i) <120 (n = 1375); (ii) 120-149 (n = 517); and (iii) ≥150 (n = 383), and QRS morphology (i) normal (n = 1252); (ii) left bundle branch block (BBB) (n = 608); and (iii) right BBB/intraventricular conduction defect (IVCD) (n = 415). The outcomes examined were the composite of cardiovascular death or heart failure hospitalization and all-cause mortality. Both abnormal QRS duration and QRS morphology were associated with higher risk, e.g. the rates of the composite outcome were: 10.2, 17.6, and 15.5 per 100 patient-years in the <120, 120-149, and ≥150 ms groups, respectively. Eplerenone reduced the risk of the primary outcome and mortality, compared with placebo, consistently across the QRS duration/morphology subgroups. CONCLUSION: We found that even moderate prolongation of QRS duration and right BBB/IVCD were associated with a high risk of adverse outcomes in HF-REF. Eplerenone was similarly effective, irrespective of QRS duration/morphology.
Authors: Joanne Simpson; Pardeep S Jhund; Lars H Lund; Sandosh Padmanabhan; Brian L Claggett; Li Shen; Mark C Petrie; William T Abraham; Akshay S Desai; Kenneth Dickstein; Lars Køber; Milton Packer; Jean L Rouleau; Guenther Mueller-Velten; Scott D Solomon; Karl Swedberg; Michael R Zile; John J V McMurray Journal: JAMA Cardiol Date: 2020-04-01 Impact factor: 14.676
Authors: Janice Y Chyou; Wan Ting Tay; Inder S Anand; Tiew-Hwa Katherine Teng; Jonathan J L Yap; Michael R MacDonald; Vijay Chopra; Seet Yoong Loh; Wataru Shimizu; Imran Zainal Abidin; Arthur Mark Richards; Javed Butler; Carolyn S P Lam Journal: J Am Heart Assoc Date: 2021-03-13 Impact factor: 5.501