Korean Circ J.  2014 Jan;44(1):22-29. 10.4070/kcj.2014.44.1.22.

Prognostic Implication of QRS Variability during Hospitalization in Patients with Acute Decompensated Heart Failure

• Lee SR
• Choi EK
• Kang DY
• Cha MJ
• Cho Y
• Oh IY
• Oh S

• KMID: 1859238
• DOI: http://doi.org/10.4070/kcj.2014.44.1.22

Abstract

BACKGROUND AND OBJECTIVES
Heart failure (HF) patients display more varied QRS duration. We investigated whether QRS variability during hospitalization for acute decompensated HF is associated with poor clinical outcomes after discharge.
SUBJECTS AND METHODS
One hundred seventy three patients (64% males; age 60+/-13 years) admitted for acute decompensated HF with severe left ventricular (LV) dysfunction (LV ejection fraction < or =35%) were consecutively enrolled. QRS variability was calculated by the difference between maximum and minimum QRS duration acquired during hospitalization. The prognostic implications on composite endpoints of death or urgent heart transplantation were analyzed.
RESULTS
Forty-two patients (24.3%) died and three patients (1.7%) underwent urgent heart transplantation during the follow-up of 51+/-18 months. Patients who reached composite endpoints (n=45) showed greater QRS variability than those who did not (n=128) (20+/-23 ms vs. 14+/-14 ms, p=0.046). Patients who had high QRS variability (more than 22 ms; n=36) tended to have a higher event rate than those with QRS variability <22 ms {39% vs. 23%, hazard ratio (HR), 1.88; 95% confidence interval (CI) 1.001-3.539, p=0.05}. Adjusting with other variables, high QRS variability was an independent predictor for composite outcome (HR 1.94; 95% CI 1.023-3.683, p=0.042).
CONCLUSION
QRS variability measured during hospitalization for acute decompensated HF has a prognostic impact in HF patients with severe LV dysfunction.

Keyword

Heart failure; Heart decompensation; Electrocardiography, variation; Prognosis

MeSH Terms

Follow-Up Studies
Heart Failure*
Heart Transplantation
Heart*
Hospitalization*
Humans
Male
Prognosis

Figure

• 

  Fig. 1 Representative QRS variability calculation. A: shows initial QRS duration (144 ms) taken on admission day. B: after HF treatment (hospital day 17), QRS duration became shortened to 108 ms. QRS variability was 36 ms. This patient has died of unknown cause during 20 months follow-up. HF: heart failure, ECG: electrocardiogram.

• 

  Fig. 2 Kaplan-Meier analysis of composite endpoints according to QRS variability. Patients with marked QRS variability showed higher event-rate than those with low QRS variability.

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