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A prolonged QRS duration predicts high mortality and morbidity after discharge in patients hospitalized for heart failure who also have reduced left ventricular ejection fraction, according to an analysis of the EVEREST trial.
“This high morbidity and mortality was observed even though patients were well treated with standard medical therapy that included β-blockers and ACE inhibitors or angiotensin receptor blockers,” said Dr. Norman C. Wang of Northwestern University, Chicago, and his associates.
Measuring QRS duration on ECG is “relatively inexpensive, simple to perform, and yields an instant result,” the investigators noted.
The EVEREST (Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan) investigators reported their main conclusions last year. They now report the results of a retrospective, post hoc analysis of data on a subset of 2,962 subjects hospitalized for heart failure at more than 350 medical centers around the world and followed for a median of 10 months. This study was supported by Otsuka Pharmaceutical Group.
Patients underwent ECG evaluation at admission and at several intervals during hospitalization. About 45% of the patients had a prolonged QRS (duration of 120 milliseconds or more).
A prolonged QRS on admission was associated with a significantly increased risk of death within 3 months (12% incidence) and at the end of follow-up (28% incidence), compared with a normal QRS on admission (7% and 19%, respectively). This represents a 24% increased risk of death with a prolonged QRS duration.
Similarly, the composite end point of cardiovascular death or rehospitalization for heart failure was significantly more common in patients with a prolonged QRS on admission, Dr. Wang and his associates said (JAMA 2008;299:2656–66).
Also, if a prolonged QRS developed during hospitalization, it was associated with increased event rates after discharge.
However, “one must be cautious in attributing mechanistic significance to the QRS widening itself” as study patients with a wide QRS consistently had a higher prevalence of many known risk factors, including older age, lower ejection fraction, faster heart rate, and higher serum blood urea nitrogen, creatinine, and brain natriuretic peptide levels, Dr. Barrie Massie said in an interview. “Importantly, they were less often treated with β-blockers and much more frequently receiving amiodarone,” added Dr. Massie, professor of medicine at the University of California, San Francisco, and chief of cardiology at the San Francisco VA Medical Center.
Most patients who died during follow-up succumbed to progressive heart failure or sudden cardiac death, Dr. Wang reported.
A prolonged QRS duration predicts high mortality and morbidity after discharge in patients hospitalized for heart failure who also have reduced left ventricular ejection fraction, according to an analysis of the EVEREST trial.
“This high morbidity and mortality was observed even though patients were well treated with standard medical therapy that included β-blockers and ACE inhibitors or angiotensin receptor blockers,” said Dr. Norman C. Wang of Northwestern University, Chicago, and his associates.
Measuring QRS duration on ECG is “relatively inexpensive, simple to perform, and yields an instant result,” the investigators noted.
The EVEREST (Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan) investigators reported their main conclusions last year. They now report the results of a retrospective, post hoc analysis of data on a subset of 2,962 subjects hospitalized for heart failure at more than 350 medical centers around the world and followed for a median of 10 months. This study was supported by Otsuka Pharmaceutical Group.
Patients underwent ECG evaluation at admission and at several intervals during hospitalization. About 45% of the patients had a prolonged QRS (duration of 120 milliseconds or more).
A prolonged QRS on admission was associated with a significantly increased risk of death within 3 months (12% incidence) and at the end of follow-up (28% incidence), compared with a normal QRS on admission (7% and 19%, respectively). This represents a 24% increased risk of death with a prolonged QRS duration.
Similarly, the composite end point of cardiovascular death or rehospitalization for heart failure was significantly more common in patients with a prolonged QRS on admission, Dr. Wang and his associates said (JAMA 2008;299:2656–66).
Also, if a prolonged QRS developed during hospitalization, it was associated with increased event rates after discharge.
However, “one must be cautious in attributing mechanistic significance to the QRS widening itself” as study patients with a wide QRS consistently had a higher prevalence of many known risk factors, including older age, lower ejection fraction, faster heart rate, and higher serum blood urea nitrogen, creatinine, and brain natriuretic peptide levels, Dr. Barrie Massie said in an interview. “Importantly, they were less often treated with β-blockers and much more frequently receiving amiodarone,” added Dr. Massie, professor of medicine at the University of California, San Francisco, and chief of cardiology at the San Francisco VA Medical Center.
Most patients who died during follow-up succumbed to progressive heart failure or sudden cardiac death, Dr. Wang reported.
A prolonged QRS duration predicts high mortality and morbidity after discharge in patients hospitalized for heart failure who also have reduced left ventricular ejection fraction, according to an analysis of the EVEREST trial.
“This high morbidity and mortality was observed even though patients were well treated with standard medical therapy that included β-blockers and ACE inhibitors or angiotensin receptor blockers,” said Dr. Norman C. Wang of Northwestern University, Chicago, and his associates.
Measuring QRS duration on ECG is “relatively inexpensive, simple to perform, and yields an instant result,” the investigators noted.
The EVEREST (Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan) investigators reported their main conclusions last year. They now report the results of a retrospective, post hoc analysis of data on a subset of 2,962 subjects hospitalized for heart failure at more than 350 medical centers around the world and followed for a median of 10 months. This study was supported by Otsuka Pharmaceutical Group.
Patients underwent ECG evaluation at admission and at several intervals during hospitalization. About 45% of the patients had a prolonged QRS (duration of 120 milliseconds or more).
A prolonged QRS on admission was associated with a significantly increased risk of death within 3 months (12% incidence) and at the end of follow-up (28% incidence), compared with a normal QRS on admission (7% and 19%, respectively). This represents a 24% increased risk of death with a prolonged QRS duration.
Similarly, the composite end point of cardiovascular death or rehospitalization for heart failure was significantly more common in patients with a prolonged QRS on admission, Dr. Wang and his associates said (JAMA 2008;299:2656–66).
Also, if a prolonged QRS developed during hospitalization, it was associated with increased event rates after discharge.
However, “one must be cautious in attributing mechanistic significance to the QRS widening itself” as study patients with a wide QRS consistently had a higher prevalence of many known risk factors, including older age, lower ejection fraction, faster heart rate, and higher serum blood urea nitrogen, creatinine, and brain natriuretic peptide levels, Dr. Barrie Massie said in an interview. “Importantly, they were less often treated with β-blockers and much more frequently receiving amiodarone,” added Dr. Massie, professor of medicine at the University of California, San Francisco, and chief of cardiology at the San Francisco VA Medical Center.
Most patients who died during follow-up succumbed to progressive heart failure or sudden cardiac death, Dr. Wang reported.