The relationship of QRS morphology with cardiac structure and function in patients with heart failure

Pellicori, P. , Joseph, A. C., Zhang, J., Lukaschuk, E., Sherwi, N., Bourantas, C. V., Loh, H., Clark, A. L. and Cleland, J. G.F. (2015) The relationship of QRS morphology with cardiac structure and function in patients with heart failure. Clinical Research in Cardiology, 104(11), pp. 935-945. (doi:10.1007/s00392-015-0861-0) (PMID:25903113)

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Abstract

Introduction: The relationship of QRS morphology with cardiac structure and function in patients with heart failure is uncertain. Methods: Patients with a clinical diagnosis of heart failure and objective evidence of cardiac dysfunction [either a left ventricular ejection fraction (LVEF) <50 % or an amino-terminal pro-brain natriuretic peptide (NT-proBNP) ≥400 pg/ml] who had been investigated by cardiac magnetic resonance imaging (CMRI) were identified. QRS duration ≥120 ms was grouped morphologically as left (LBBB), right bundle branch block (RBBB) or indeterminate. Results: Of 877 patients, 320 (36 %) had QRS ≥ 120 ms. Compared to patients with LBBB, those with RBBB had a lower median [inter-quartile range (IQR)] right ventricular (RV) ejection fraction [RBBB: 46 (37–57); LBBB: 52 (42–61) %; p = 0.014], greater median (IQR) RV mass [RBBB: 53 (42–73); LBBB: 45 (36–56) g; p < 0.001], higher median (IQR) plasma NT-proBNP [RBBB: 2013 (659–3573); LBBB: 1159 (589–2207) pg/ml, p = 0.026], more signs of peripheral congestion and higher prevalence of atrial fibrillation but had similar LVEF. During a median follow-up of 1302 days (IQR: 742–2237), 311 patients died. Compared with patients who had QRS < 120 ms, those with RBBB [HR 1.98, 95 % CI (1.37–2.86); p < 0.001] had a higher mortality. Age and NT-proBNP were the strongest independent predictors of mortality; neither QRS nor CMRI variables improved prediction. Conclusions: In patients with heart failure and QRS ≥ 120 ms, RBBB is associated with more severe RV dysfunction and congestion and a worse prognosis. However, neither QRS morphology nor CMRI data provide independent prognostic information in a multivariable analysis including NT-proBNP.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Cleland, Professor John and Pellicori, Dr Pierpaolo
Authors: Pellicori, P., Joseph, A. C., Zhang, J., Lukaschuk, E., Sherwi, N., Bourantas, C. V., Loh, H., Clark, A. L., and Cleland, J. G.F.
Subjects:R Medicine > R Medicine (General)
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:Clinical Research in Cardiology
Publisher:Springer
ISSN:1861-0684
ISSN (Online):1861-0692
Published Online:23 April 2015

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