Objectives To quantify the prognostic utility of QRS and QTc interval prolongation in patients presenting with acute destabilized heart failure (ADHF) to the emergency department (ED).
Design Prospective cohort study among patients enrolled in the B-type natriuretic peptide for Acute Shortness of Breath Evaluation (BASEL) study. QRS and QT intervals were measured in 173 consecutive patients with ADHF. QT interval was corrected using the Bazett formula. The primary end point was all-cause mortality during 720-day follow-up.
Results QRS interval was prolonged (≥120 ms) in 27% of patients, and QTc interval was prolonged (≥440 ms) in 72% of patients. Baseline demographic and clinical characteristics were comparable in patients with normal and prolonged QRS or QTc interval. A total of 78 patients died during follow-up. Interestingly, 720-day mortality rate was similar in patients with prolonged and normal QTc (44% versus 42%, P=0.546), but was significantly higher in patients with prolonged QRS interval versus patients with normal QRS (59% versus 37%, P=0.004). In Cox proportional hazard analysis, prolonged QRS interval was associated with a nearly two-fold increase in mortality (hazard ratio 1.94, 95% CI 1.22-3.07; P=0.005). This association persisted after adjustment for variables routinely available in the ED.
Conclusions Prolonged QRS interval, but not prolonged QTc interval, is associated with increased long-term mortality in patients with ADHF.
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