Clinical outcomes according to QRS duration and morphology in the irbesartan in patients with heart failure and preserved systolic function (I-Preserve) trial

Cannon, J. A., Shen, L., Jhund, P. , Anand, I. S., Komajda, M., McKelvie, R. S., Zile, M. R., Carson, P. E. and McMurray, J. J. V. (2016) Clinical outcomes according to QRS duration and morphology in the irbesartan in patients with heart failure and preserved systolic function (I-Preserve) trial. European Journal of Heart Failure, 18(8), pp. 1021-1031. (doi: 10.1002/ejhf.547) (PMID:27194023)

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Abstract

Background: The aims of this study were to describe the prevalence of QRS prolongation and abnormal QRS morphology in patients with heart failure and preserved ejection fraction (HF-PEF) and to examine the relationship between these QRS abnormalities and clinical outcomes. Methods: We categorized patients in the Irbesartan in Patients with Heart Failure and Preserved Ejection Fraction trial (I-Preserve) according to QRS duration <120 vs. ≥120 milliseconds and QRS morphology: normal, left bundle branch block (LBBB) and right bundle branch block (RBBB) or other non-specific intra-ventricular conduction defect (IVCD). The outcomes examined were the composite of cardiovascular death or heart failure hospitalization (and its components) and all-cause mortality. Results: Of the 4128 patients enrolled in I-Preserve, 3754 were included in the current analyses. 606 patients had a QRS duration ≥120 milliseconds. 302 had LBBB and 742 had RBBB/IVCD. Patients with an abnormal QRS had evidence of more severe heart failure (lower LVEF, lower eGFR, higher NT pro-BNP) and worse clinical status (higher NYHA functional class, greater use of diuretics). Both abnormalities of QRS duration and QRS morphology were associated with worse outcomes. The rates of the composite outcome were: 6.0 and 9.3 per 100 patient years in the <120 and ≥120 millisecond groups, respectively (adjusted hazard ratio [HR] 1.32, 1.11-1.57; P=0.002) and 6.0, 7.7 and 8.7 per 100 patient years in the normal, non-LBBB and LBBB groups respectively (adjusted HR 1.19, 1.00-1.42; P=0.046 and 1.31, 1.03-1.66; P=0.026, respectively, compared with normal). The heightened risk related to QRS abnormalities persisted after adjustment for other prognostic variables, including NT pro-BNP. Conclusion: We found that both prolongation of QRS duration and abnormal QRS morphology were associated with a high risk of fatal and non-fatal adverse outcomes in HF-PEF.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Cannon, Dr Jane and Jhund, Dr Pardeep and McMurray, Professor John
Authors: Cannon, J. A., Shen, L., Jhund, P., Anand, I. S., Komajda, M., McKelvie, R. S., Zile, M. R., Carson, P. E., and McMurray, J. J. V.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:European Journal of Heart Failure
Publisher:Oxford University Press
ISSN:1388-9842
ISSN (Online):1879-0844
Published Online:15 May 2016
Copyright Holders:Copyright © 2016 Oxford University Press
First Published:First published in European Journal of Heart Failure 18(8):1021-1031
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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