Clinical outcomes according to QRS duration and morphology in the eplerenone in mild patients: hospitalization and survIval study in heart failure (EMPHASIS-HF)

Cannon, J.A. et al. (2015) Clinical outcomes according to QRS duration and morphology in the eplerenone in mild patients: hospitalization and survIval study in heart failure (EMPHASIS-HF). European Journal of Heart Failure, 17(7), pp. 707-716. (doi: 10.1002/ejhf.303) (PMID:26139584)

Abstract

Aims We examined the relationship between different degrees of QRS prolongation and different QRS morphologies and clinical outcomes in patients with heart failure, reduced ejection fraction (HF-REF), and mild symptoms in the Eplerenone in Mild Patients Hospitalization and SurvIval Study in Heart Failure trial (EMPHASIS-HF). We also evaluated the effect of eplerenone in these patients according to QRS duration/morphology. Methods and results Patients were categorized as: QRS duration (ms) (i) <120 (n = 1375); (ii) 120–149 (n = 517); and (iii) ≥150 (n = 383), and QRS morphology (i) normal (n = 1252); (ii) left bundle branch block (BBB) (n = 608); and (iii) right BBB/intraventricular conduction defect (IVCD) (n = 415). The outcomes examined were the composite of cardiovascular death or heart failure hospitalization and all-cause mortality. Both abnormal QRS duration and QRS morphology were associated with higher risk, e.g. the rates of the composite outcome were: 10.2, 17.6, and 15.5 per 100 patient-years in the <120, 120–149, and ≥150 ms groups, respectively. Eplerenone reduced the risk of the primary outcome and mortality, compared with placebo, consistently across the QRS duration/morphology subgroups. Conclusion We found that even moderate prolongation of QRS duration and right BBB/IVCD were associated with a high risk of adverse outcomes in HF-REF. Eplerenone was similarly effective, irrespective of QRS duration/morphology.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Cannon, Dr Jane and McMurray, Professor John
• Authors: Cannon, J.A., Collier, T.J., Shen, L., Swedberg, K., Krum, H., Van Veldhuisen, D.J., Vincent, J., Pocock, S.J., Pitt, B., Zannad, F., 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: Wiley
• ISSN: 1388-9842
• ISSN (Online): 1879-0844