Jung Ae Hong1, Min-Seok Kim1, Hanbit Park1, Sang Eun Lee1, Hae-Young Lee2, Hyun-Jai Cho2, Jin Oh Choi3, Eun-Seok Jeon3, Kyung-Kuk Hwang4, Shung Chull Chae5, Sang Hong Baek6, Seok-Min Kang7, Dong-Ju Choi8, Byung-Su Yoo9, Kye Hun Kim10, Myeong-Chan Cho5, Jae-Joong Kim1, Byung-Hee Oh11. 1. Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. 2. Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea. 3. Department of Internal Medicine, Sungkyunkwan University College of Medicine, Seoul, Korea. 4. Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea. 5. Department of Internal Medicine, Kyungpook National University College of Medicine, Daegu, Korea. 6. Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea. 7. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. 8. Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. 9. Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea. 10. Heart Research Center of Chonnam National University, Gwangju, Korea. 11. Division of Cardiology, Cardiovascular Center, Mediplex Sejong Hospital, Incheon, Korea.
Abstract
Background and Objectives: Prolonged QRS duration is associated with poor outcomes in patients with chronic heart failure (HF). However, the prognostic value of QRS duration in patients with cardiogenic shock complicating acute HF remains unknown. We evaluated the hypothesis that prolonged QRS duration may be associated with short-term mortality among acute HF patients with cardiogenic shock (CS). Methods: From March 2011 through December 2013, a total of 5,625 acute HF patients were consecutively enrolled in ten tertiary university hospitals. Among them, we analyzed patients who presented with CS. Patients were divided into three groups by QRS duration cutoff values of 130 and 150 ms. The primary endpoint was 30-day in-hospital mortality. Results: Two hundred eleven patients presented with CS at admission and those with available electrocardiograms were included in this analysis. There were 35 patients with QRS durations of 150 ms or above, 30 patients with QRS durations between 130 ms and 150 ms, and 146 patients with QRS durations below 130 ms. The 30-day all cause in-hospital mortality rates were 43.7%, 33.1%, and 24.9%, respectively. After multivariate adjustment, severe prolonged QRS duration was a significant prognostic factor for 30-day in-hospital mortality (hazard ratio, 1.909; 95% confidence interval, 1.024-3.558; p=0.042). Conclusions: Prolonged QRS duration was associated with a higher risk of 30-day in-hospital mortality among patients with acute HF who presented with CS. Trial Registration: ClinicalTrials.gov Identifier: NCT01389843.
Background and Objectives: Prolonged QRS duration is associated with poor outcomes in patients with chronic heart failure (HF). However, the prognostic value of QRS duration in patients with cardiogenic shock complicating acute HF remains unknown. We evaluated the hypothesis that prolonged QRS duration may be associated with short-term mortality among acute HF patients with cardiogenic shock (CS). Methods: From March 2011 through December 2013, a total of 5,625 acute HF patients were consecutively enrolled in ten tertiary university hospitals. Among them, we analyzed patients who presented with CS. Patients were divided into three groups by QRS duration cutoff values of 130 and 150 ms. The primary endpoint was 30-day in-hospital mortality. Results: Two hundred eleven patients presented with CS at admission and those with available electrocardiograms were included in this analysis. There were 35 patients with QRS durations of 150 ms or above, 30 patients with QRS durations between 130 ms and 150 ms, and 146 patients with QRS durations below 130 ms. The 30-day all cause in-hospital mortality rates were 43.7%, 33.1%, and 24.9%, respectively. After multivariate adjustment, severe prolonged QRS duration was a significant prognostic factor for 30-day in-hospital mortality (hazard ratio, 1.909; 95% confidence interval, 1.024-3.558; p=0.042). Conclusions: Prolonged QRS duration was associated with a higher risk of 30-day in-hospital mortality among patients with acute HF who presented with CS. Trial Registration: ClinicalTrials.gov Identifier: NCT01389843.
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