Matthew J Singleton1, Charles German2, Krupal J Hari3, Georgia Saylor4, David M Herrington5, Elsayed Z Soliman6, Barry I Freedman7, Donald W Bowden8, Prashant D Bhave9, Joseph Yeboah10. 1. Section on Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, North Carolina, 1 Medical Center Blvd, Winston-Salem, NC 27157, United States of America. Electronic address: mjsingle@wakehealth.edu. 2. Section on Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, North Carolina, 1 Medical Center Blvd, Winston-Salem, NC 27157, United States of America. Electronic address: cgerman@wakehealth.edu. 3. Section on Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, North Carolina, 1 Medical Center Blvd, Winston-Salem, NC 27157, United States of America. Electronic address: khari@wakehealth.edu. 4. Section on Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, North Carolina, 1 Medical Center Blvd, Winston-Salem, NC 27157, United States of America. Electronic address: gsaylor@wakehealth.edu. 5. Section on Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, North Carolina, 1 Medical Center Blvd, Winston-Salem, NC 27157, United States of America. Electronic address: dherring@wakehealth.edu. 6. Section on Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, North Carolina, 1 Medical Center Blvd, Winston-Salem, NC 27157, United States of America; Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC, United States of America. Electronic address: esoliman@wakehealth.edu. 7. Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, North Carolina, 1 Medical Center Blvd, Winston-Salem, NC 27157, United States of America. Electronic address: bfreedma@wakehealth.edu. 8. Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, North Carolina, 1 Medical Center Blvd, Winston-Salem, NC 27157, United States of America. Electronic address: dbowden@wakehealth.edu. 9. Section on Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, North Carolina, 1 Medical Center Blvd, Winston-Salem, NC 27157, United States of America. Electronic address: pbhave@wakehealth.edu. 10. Section on Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, North Carolina, 1 Medical Center Blvd, Winston-Salem, NC 27157, United States of America. Electronic address: jyeboah@wakehealth.edu.
Abstract
BACKGROUND: QRS-duration predicts mortality in patients with heart failure and, to a lesser extent, the general population. However, in patients with diabetes, its prognostic significance is unknown. To better understand how QRS-duration relates to mortality among those with diabetes, we explored survival as a function of QRS-duration in the Diabetes Heart Study. METHODS: The study population included 1335 participants. Cox proportional hazards modeling was used to evaluate the relationship between QRS-duration and all-cause mortality, comparing those with QRS-duration ≤120 vs. >120 (ms). Multivariable models adjusted for age, sex, race, hypertension, smoking, years with diabetes, BMI, systolic blood pressure, cholesterol, triglycerides, glomerular filtration rate, and hemoglobin A1c. RESULTS AND CONCLUSIONS: Participants were: mean age 61 ± 9, 55% women, 83% white; 99 participants (7.5%) had a QRS-duration >120. After 11,000 person-years of follow-up (median 8.5 years; maximum 13.9 years), 266 participants had died (20%). Participants with baseline QRS-duration >120 had an adjusted hazard ratio for all-cause mortality of 1.56 (95% CI 1.05-2.24; p = 0.027). Modeling QRS-duration as a continuous variable, we found an 11% increase in all-cause mortality for each 10 ms increase in QRS-duration. In conclusion, QRS-duration is associated with subsequent all-cause mortality among those with type 2 diabetes-participants with QRS-duration >120 ms had a 56% increase in all-cause mortality, even after adjustment for conventional risk factors. Given the ubiquitous presence of ECG data in the medical record, QRS-duration may prove to be a useful prognostic measure, especially among those with diabetes.
BACKGROUND: QRS-duration predicts mortality in patients with heart failure and, to a lesser extent, the general population. However, in patients with diabetes, its prognostic significance is unknown. To better understand how QRS-duration relates to mortality among those with diabetes, we explored survival as a function of QRS-duration in the Diabetes Heart Study. METHODS: The study population included 1335 participants. Cox proportional hazards modeling was used to evaluate the relationship between QRS-duration and all-cause mortality, comparing those with QRS-duration ≤120 vs. >120 (ms). Multivariable models adjusted for age, sex, race, hypertension, smoking, years with diabetes, BMI, systolic blood pressure, cholesterol, triglycerides, glomerular filtration rate, and hemoglobin A1c. RESULTS AND CONCLUSIONS:Participants were: mean age 61 ± 9, 55% women, 83% white; 99 participants (7.5%) had a QRS-duration >120. After 11,000 person-years of follow-up (median 8.5 years; maximum 13.9 years), 266 participants had died (20%). Participants with baseline QRS-duration >120 had an adjusted hazard ratio for all-cause mortality of 1.56 (95% CI 1.05-2.24; p = 0.027). Modeling QRS-duration as a continuous variable, we found an 11% increase in all-cause mortality for each 10 ms increase in QRS-duration. In conclusion, QRS-duration is associated with subsequent all-cause mortality among those with type 2 diabetes-participants with QRS-duration >120 ms had a 56% increase in all-cause mortality, even after adjustment for conventional risk factors. Given the ubiquitous presence of ECG data in the medical record, QRS-duration may prove to be a useful prognostic measure, especially among those with diabetes.
Authors: Anupam C A Rao; Austin C C Ng; Raymond W Sy; Karin K M Chia; Peter S Hansen; Joseph Chiha; Jens Kilian; Logan B Kanagaratnam Journal: Int J Cardiol Heart Vasc Date: 2021-10-06