Journal of Cardiac Failure
Volume 15, Issue 7 , Pages 553-560 , September 2009

Prolonged Electrocardiogram QRS Duration Independently Predicts Long-Term Mortality in Patients Hospitalized for Heart Failure With Preserved Systolic Function

  • Scott L. Hummel, MD, MS

      Affiliations

    • Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
    • Corresponding Author InformationCorrespondence to: Scott L. Hummel, MD, MS, 1500 East Medical Center Drive, CVC Room 2383, SPC 5853, Ann Arbor, MI 48109. Tel: (734) 936-5265; Fax: (734) 232-4132.
  • ,
  • Stephen Skorcz, MPH

      Affiliations

    • Greater Flint Health Coalition, Flint, MI
  • ,
  • Todd M. Koelling, MD, FACC

      Affiliations

    • Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI

Received 8 October 2008 ,Revised 11 February 2009 ,Accepted 19 February 2009.

References 

  1. Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM. Trends in prevalence and outcome of heart failure with preserved ejection fraction. [see comment] N Engl J Med. 2006;355:251–259
  2. Tribouilloy C, Rusinaru D, Mahjoub H, Souliere V, Levy F, Peltier M, et al. Prognosis of heart failure with preserved ejection fraction: a 5 year prospective population-based study. Eur Heart J. 2008;29:339–347
  3. Lee DS, Austin PC, Rouleau JL, Liu PP, Naimark D, Tu JV. Predicting mortality among patients hospitalized for heart failure: derivation and validation of a clinical model. JAMA. 2003;290:2581–2587
  4. Yusuf S, Pfeffer MA, Swedberg K, Granger CB, Held P, McMurray JJ, et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-preserved trial. [see comment] Lancet. 2003;362:777–781
  5. Ahmed A, Rich MW, Fleg JL, Zile MR, Young JB, Kitzman DW, et al. Effects of digoxin on morbidity and mortality in diastolic heart failure: the ancillary Digitalis Investigation Group trial. Circulation. 2006;114:397–403
  6. Al-Khatib SM, Shaw LK, O'Connor C, Kong M, Califf RM. Incidence and predictors of sudden cardiac death in patients with diastolic heart failure. J Cardiovasc Electrophysiol. 2007;18:1231–1235
  7. Judge KW, Pawitan Y, Caldwell J, Gersh BJ, Kennedy JW. Congestive heart failure symptoms in patients with preserved left ventricular systolic function: analysis of the Cass registry. J Am Coll Cardiol. 1991;18:377–382
  8. Yancy CW, Lopatin M, Stevenson LW, De Marco T, Fonarow GC, et al. Clinical presentation, management, and in-hospital outcomes of patients admitted with acute decompensated heart failure with preserved systolic function: a report from the Acute Decompensated HEart failure national REgistry (ADHERE) database. J Am Coll Cardiol. 2006;47:76–84
  9. Baldasseroni S, Opasich C, Gorini M, Lucci D, Marchionni N, Marini M, et al. Left bundle-branch block is associated with increased 1-year sudden and total mortality rate in 5517 outpatients with congestive heart failure: a report from the Italian network on congestive heart failure. Am Heart J. 2002;143:398–405
  10. Aaronson KD, Schwartz JS, Chen TM, Wong KL, Goin JE, Mancini DM. Development and prospective validation of a clinical index to predict survival in ambulatory patients referred for cardiac transplant evaluation. Circulation. 1997;95:2660–2667
  11. Wang NC, Maggioni AP, Konstam MA, Zannad F, Krasa HB, Burnett JC, et al. Clinical implications of QRS duration in patients hospitalized with worsening heart failure and reduced left ventricular ejection fraction. JAMA. 2008;299:2656–2666
  12. Levy WC, Mozaffarian D, Linker DT, Sutradhar SC, Anker SD, Cropp AB, et al. The Seattle Heart Failure Model: prediction of survival in heart failure. Circulation. 2006;113:1424–1433
  13. Bleeker GB, Schalij MJ, Molhoek SG, Verwey HF, Holman ER, Boersma E, et al. Relationship between QRS duration and left ventricular dyssynchrony in patients with end-stage heart failure. J Cardiovasc Electrophysiol. 2004;15:544–549
  14. Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005;352:1539–1549
  15. Danciu SC, Gonzalez J, Gandhi N, Sadhu S, Herrera CJ, Kehoe R. Comparison of six-month outcomes and hospitalization rates in heart failure patients with and without preserved left ventricular ejection fraction and with and without intraventricular conduction defect. Am J Cardiol. 2006;97:256–259
  16. Wang J, Kurrelmeyer KM, Torre-Amione G, Nagueh SF. Systolic and diastolic dyssynchrony in patients with diastolic heart failure and the effect of medical therapy. J Am Coll Cardiol. 2007;49:88–96
  17. Kass DA. An epidemic of dyssynchrony: but what does it mean?. J Am Coll Cardiol. 2008;51:12–17
  18. Yu C-M, Zhang Q, Yip GWK, Lee P-W, Kum LCC, Lam Y-Y, et al. Diastolic and systolic asynchrony in patients with diastolic heart failure: a common but ignored condition. [see comment] J Am Coll Cardiol. 2007;49:97–105
  19. Shenkman HJ, Pampati V, Khandelwal AK, McKinnon J, Nori D, Kaatz S, et al. Congestive heart failure and qrs duration: establishing prognosis study. Chest. 2002;122:528–534
  20. Maurer MS, King DL, El-Khoury Rumbarger L, Packer M, Burkhoff D. Left heart failure with a normal ejection fraction: identification of different pathophysiologic mechanisms. J Card Fail. 2005;11:177–187
  21. Hunt SA, Baker DW, Chin MH, Cinquegrani MP, Feldman AM, Francis GS, et al. ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary. A report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee to revise the 1995 guidelines for the evaluation and management of heart failure). J Am Coll Cardiol. 2001;38:2101–2113
  22. Eagle KA, Montoye CK, Riba AL, DeFranco AC, Parrish R, Skorcz S, et al. Guideline-based standardized care is associated with substantially lower mortality in medicare patients with acute myocardial infarction: the American College of Cardiology's Guidelines Applied in Practice (GAP) projects in Michigan. J Am Coll Cardiol. 2005;46:1242–1248
  23. Bhatia RS, Tu JV, Lee DS, Austin PC, Fang J, Haouzi A, et al. Outcome of heart failure with preserved ejection fraction in a population-based study. N Engl J Med. 2006;355:260–269
  24. Vasan RS, Levy D. Defining diastolic heart failure: a call for standardized diagnostic criteria. [see comment] Circulation. 2000;101:2118–2121
  25. Yturralde RF, Gaasch WH. Diagnostic criteria for diastolic heart failure. Prog Cardiovasc Dis. 2005;47:314–319
  26. Murkofsky RL, Dangas G, Diamond JA, Mehta D, Schaffer A, Ambrose JA. A prolonged qrs duration on surface electrocardiogram is a specific indicator of left ventricular dysfunction. J Am Coll Cardiol. 1998;32:476–482
  27. Gheorghiade M, Abraham WT, Albert NM, Greenberg BH, O'Connor CM, She L, et al. Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure. [see comment] JAMA. 2006;296:2217–2226
  28. Ghio S, Freemantle N, Serio A, Magrini G, Scelsi L, Pasotti M, et al. Baseline echocardiographic characteristics of heart failure patients enrolled in a large European multicentre trial (CARE-HF; CArdiac REsynchronisation Heart Failure study). Eur J Echocardiogr. 2006;7:373–378
  29. Cho G-Y, Song J-K, Park W-J, Han S-W, Choi S-H, Doo Y-C, et al. Mechanical dyssynchrony assessed by tissue Doppler imaging is a powerful predictor of mortality in congestive heart failure with normal QRS duration. J Am Coll Cardiol. 2005;46:2237–2243
  30. Wang YC, Hwang JJ, Lai LP, Tsai CT, Lin LC, Katra R, et al. Coexistence and exercise exacerbation of intraleft ventricular contractile dyssynchrony in hypertensive patients with diastolic heart failure. Am Heart J. 2007;154:278–284
  31. O'Connor CM, Gattis WA, Shaw L, Cuffe MS, Califf RM. Clinical characteristics and long-term outcomes of patients with heart failure and preserved systolic function. Am J Cardiol. 2000;86:863–867
  32. Heart Failure Society of America . Executive summary: HFSA 2006 comprehensive heart failure practice guideline. J Card Fail. 2006;12:10–38
  33. Yerra L, Anavekar N, Skali H, Zelenkofske S, Velazquez E, McMurray J, et al. Association of QRS duration and outcomes after myocardial infarction: the VALIANT trial. Heart Rhythm. 2006;3:313–316
  34. Triola B, Olson MB, Reis SE, Rautaharju P, Merz CNB, Kelsey SF, et al. Electrocardiographic predictors of cardiovascular outcome in women: the National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE) study. J Am Coll Cardiol. 2005;46:51–56
  35. Hesse B, Diaz LA, Snader CE, Blackstone EH, Lauer MS. Complete bundle branch block as an independent predictor of all-cause mortality: report of 7,073 patients referred for nuclear exercise testing. Am J Med. 2001;110:253–259
  36. Jain AC, Mehta MC. Etiologies of left bundle branch block and correlations with hemodynamic and angiographic findings. Am J Cardiol. 2003;91:1375–1378
  37. Dhingra R, Ho Nam B, Benjamin EJ, Wang TJ, Larson MG, D'Agostino SRB, et al. Cross-sectional relations of electrocardiographic QRS duration to left ventricular dimensions: the Framingham Heart Study. J Am Coll Cardiol. 2005;45:685–689
  38. Sekiguchi M, Yazaki Y, Isobe M, Hiroe M. Cardiac sarcoidosis: diagnostic, prognostic, and therapeutic considerations. Cardiovasc Drugs Ther. 1996;10:495–510
  39. Chapelon-Abric C, de Zuttere D, Duhaut P, Veyssier P, Wechsler B, Huong DLT, et al. Cardiac sarcoidosis: a retrospective study of 41 cases. Medicine (Balt). 2004;83:315–334
  40. Ridolfi RL, Bulkley BH, Hutchins GM. The conduction system in cardiac amyloidosis: clinical and pathologic features of 23 patients. Am J Med. 1977;62:677–686
  41. Reisinger J, Dubrey SW, Lavalley M, Skinner M, Falk RH. Electrophysiologic abnormalities in AL (primary) amyloidosis with cardiac involvement. J Am Coll Cardiol. 1997;30:1046–1051
  42. Hancock EW. Cardiomyopathy: Differential diagnosis of restrictive cardiomyopathy and constrictive pericarditis. Heart. 2001;86:343–349
  43. Bongioanni S, Bianchi F, Migliardi A, Gnavi R, Pron PG, Casetta M, et al. Relation of QRS duration to mortality in a community-based cohort with hypertrophic cardiomyopathy. Am J Cardiol. 2007;100:503–506
  44. Persson H, Lonn E, Edner M, Baruch L, Lang CC, Morton JJ, et al. Diastolic dysfunction in heart failure with preserved systolic function: need for objective evidence: results from the CHARM echocardiographic substudy-CHARMES. J Am Coll Cardiol. 2007;49:687–694

 Funded by Greater Flint Health Coalition, AstraZeneca Pharmaceuticals, Pfizer, Inc., GlaxoSmithKline, Blue Cross Blue Shield of Michigan Foundation. S.L.H. is supported by an NIH T-32 research training grant, 5T32HL007853-10.

PII: S1071-9164(09)00059-1

doi: 10.1016/j.cardfail.2009.02.002

Journal of Cardiac Failure
Volume 15, Issue 7 , Pages 553-560 , September 2009