Rahul Jain1,2, Sandeep Gautam3, Colin Wu4,5, Changyu Shen6, Aditya Jain4, Ola Giesdal4, Harjit Chahal4, Hongbo Lin6, David A Bluemke7, Elsayed Z Soliman8, Saman Nazarian4, João A C Lima4. 1. Department of Cardiology, Krannert Institute of Cardiology, Indiana University School of Medicine, 1800 N. Capitol Avenue, Indianapolis, IN, 46202, USA. rahujain@iu.edu. 2. Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA. rahujain@iu.edu. 3. Division of Cardiovascular Medicine, University of Missouri, Columbia, MO, USA. 4. Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA. 5. Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD, USA. 6. Department of Biostatistics, School of Medicine and Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA. 7. Radiology and Imaging Sciences, National Institute of Health, Bethesda, MD, USA. 8. Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention and Department of Internal Medicine, Cardiology Section, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Abstract
BACKGROUND: QRS dispersion measured as the difference between maximal and minimal QRS duration in the standard 12-lead electrocardiogram has been shown to be associated with increased mortality in heart failure (HF) patients and increased arrhythmic events in patients with cardiomyopathy. AIMS: This study sought to examine the prognostic association between baseline QRS dispersion and future cardiovascular events in individuals without known prior cardiovascular disease. METHODS: The association of QRS dispersion with cardiovascular events was examined in 6510 MESA (Multi-Ethnic Study of Atherosclerosis) participants. Participants with bundle branch block were excluded. Study participants were divided into two groups based on the 95th percentile of QRS dispersion (QRS dispersion < 34 ms [group I] and QRS dispersion ≥ 34 ms [group II]). Cox proportional hazard models adjusting for demographic and clinical risk factors were used to examine the association of QRS dispersion with incident cardiovascular events (major adverse cardiovascular events [MACE]) and mortality. Analysis was repeated by forcing Framingham risk factors. RESULTS: Mean age was 62 ± 10 years in group I and 63 ± 10 years in group II (P = 0.02). QRS dispersion ≥ 34 ms was associated significantly with MACE (HR 1.30; 95% CI 1.04-1.62) and mortality (HR 1.33; 95% CI 1.03-1.73) after adjustment for cardiovascular risk factors and potential cofounders. Similar results were seen for mortality after adjustment for Framingham risk factors. CONCLUSION: QRS dispersion ≥ 34 ms predicts cardiovascular events and mortality.
BACKGROUND: QRS dispersion measured as the difference between maximal and minimal QRS duration in the standard 12-lead electrocardiogram has been shown to be associated with increased mortality in heart failure (HF) patients and increased arrhythmic events in patients with cardiomyopathy. AIMS: This study sought to examine the prognostic association between baseline QRS dispersion and future cardiovascular events in individuals without known prior cardiovascular disease. METHODS: The association of QRS dispersion with cardiovascular events was examined in 6510 MESA (Multi-Ethnic Study of Atherosclerosis) participants. Participants with bundle branch block were excluded. Study participants were divided into two groups based on the 95th percentile of QRS dispersion (QRS dispersion < 34 ms [group I] and QRS dispersion ≥ 34 ms [group II]). Cox proportional hazard models adjusting for demographic and clinical risk factors were used to examine the association of QRS dispersion with incident cardiovascular events (major adverse cardiovascular events [MACE]) and mortality. Analysis was repeated by forcing Framingham risk factors. RESULTS: Mean age was 62 ± 10 years in group I and 63 ± 10 years in group II (P = 0.02). QRS dispersion ≥ 34 ms was associated significantly with MACE (HR 1.30; 95% CI 1.04-1.62) and mortality (HR 1.33; 95% CI 1.03-1.73) after adjustment for cardiovascular risk factors and potential cofounders. Similar results were seen for mortality after adjustment for Framingham risk factors. CONCLUSION: QRS dispersion ≥ 34 ms predicts cardiovascular events and mortality.
Entities:
Keywords:
Heart failure; Major adverse cardiovascular events; Mortality; Multi-Ethnic Study of Atherosclerosis; QRS dispersion
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