CARDIOVASCULAR MEDICINE

Incremental changes in QRS duration in serial ECGs over time identify high risk elderly patients with heart failure

W Shamim, M Yousufuddin, M Cicoria, D G Gibson, A J S Coats, M Y Henein

Royal Brompton Hospital and National Heart and Lung Institute, Sydney Street, London SW3 6NP, UK;m.henein{at}rbh.nthames.nhs.uk

Correspondence to:
Correspondence to:
Dr Michael Henein, Cardiac Department, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK;
m.henein{at}rbh.nthames.nhs.uk

Aims: To investigate the hypothesis that changes in the ECG over time may be an important and readily available marker of prognostic value in patients with heart failure.

Methods: 112 elderly patients (81 men) with stable heart failure, a mean (SD) age of 73.3 (4.4) years, left ventricular ejection fraction 38 (17)%, and peak oxygen consumption 15.1 (4.7) ml/kg/min had ECG measurements on two occasions a minimum of 12 (5) months apart.

Results: During the subsequent follow up period (mean 27 (17) months) 45 patients died. QRS duration (p = 0.001) and heart rate (p = 0.03) at baseline were found by Cox proportional hazard method analysis to predict adverse outcomes in these patients. Of the changes in ECG parameters between the first and second visit, broadening of QRS duration (p = 0.001) predicted mortality. On Kaplan-Meier survival analysis, patients with < 5% change in QRS duration had fewer end points than patients with 5–20% change. A > 20% increase in QRS duration was associated with the worst prognosis. Progressive prolongation of QRS duration correlated closely with deterioration of LV systolic and diastolic function.

Conclusion: A single measurement of QRS duration has significant prognostic value in elderly patients with heart failure and the increase in QRS duration over time is an even better predictor of adverse out comes.

Keywords: heart failure; elderly; QRS duration; prognosis; electrocardiography; echocardiography

Abbreviations: AUC, area under the curve; EDD, end diastolic diameter; ESD, end systolic diameter; IVRT, isovolumic relaxation time; LV, left ventricular; LVEF, left ventricular ejection fraction; NYHA, New York Heart Association; QTc, corrected QT interval

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