Electroanatomic ratios and mortality in patients with heart failure: insights from the ASIAN-HF registry
Document Type
Article
Publication Date
3-16-2021
Abstract
BACKGROUND: QRS duration (QRSd) is a marker of electrical remodeling in heart failure. Anthropometrics and left ventricular size may influence QRSd and, in turn, may influence the association between QRSd and heart failure outcomes. METHODS AND RESULTS: Using the prospective, multicenter, multinational ASIAN-HF (Asian Sudden Cardiac Death in Heart Failure) registry, this study evaluated whether electroanatomic ratios (QRSd indexed for height or left ventricular end-diastole volume) are associated with 1-year mortality in individuals with heart failure with reduced ejection fraction. The study included 4899 individuals (aged 60 +/- 19 years, 78% male, mean left ventricular ejection fraction: 27.3 +/- 7.1%). In the overall cohort, QRSd was not associated with all-cause mortality (hazard ratio HR], 1.003; 95% CI, 0.999-1.006, P=0.142) or sudden cardiac death (HR, 1.006; 95% CI, 1.000-1.013, P=0.059). QRS/height was associated with all-cause mortality (HR, 1.165; 95% CI, 1.046-1.296, P=0.005 with interaction by sex p(interaction)=0.020) and sudden cardiac death (HR, 1.270; 95% CI, 1.021-1.580, P=0.032). QRS/left ventricular end-diastole volume was associated with all-cause mortality (HR, 1.22; 95% CI, 1.05-1.43, P=0.011) and sudden cardiac death (HR, 1.461; 95% CI, 1.090-1.957, P=0.011) in patients with nonischemic cardiomyopathy but not in patients with ischemic cardiomyopathy (all-cause mortality: HR, 0.94; 95% CI, 0.79-1.11, P=0.467; sudden cardiac death: HR, 0.734; 95% CI, 0.477-1.132, P=0.162). CONCLUSIONS: Electroanatomic ratios of QRSd indexed for body size or left ventricular size are associated with mortality in individuals with heart failure with reduced ejection fraction. In particular, increased QRS/height may be a marker of high risk in individuals with heart failure with reduced ejection fraction, and QRS/left ventricular end-diastole volume may further risk stratify individuals with nonischemic heart failure with reduced ejection fraction.
Keywords
electroanatomic remodeling, heart failure, height, left ventricle size, mortality, QRS, sudden cardiac death
Divisions
ummc
Funders
Boston Scientific Investigator Sponsored Research Program, National Medical Research Council of Singapore [R-172-003-219-511],A*STAR Biomedical Research Council Asian neTwork for Translational Research and Cardiovascular Trials (ATTRaCT) program [SPF2014/003] [SPF2014/004] [SPF2014/005],Bayer AG
Publication Title
Journal of The American Heart Association
Volume
10
Issue
6
Publisher
Wiley
Publisher Location
111 RIVER ST, HOBOKEN 07030-5774, NJ USA