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Relationship between QRS duration and left ventricular mass and volume in patients at high cardiovascular risk
  1. Ralph A Stewart1,2,
  2. Alistair A Young1,
  3. Craig Anderson3,
  4. Koon K Teo4,
  5. Garry Jennings5,
  6. Brett R Cowan1
  1. 1The Centre for Advanced Cardiac Magnetic Imaging, The University of Auckland, Auckland, New Zealand
  2. 2Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
  3. 3Neurological and Mental Health Division, The George Institute for International Health, Sydney, Australia
  4. 4Population Health Research Institute, McMaster University, Hamilton, Canada
  5. 5Baker Heart and Diabetes Institute, Melbourne, Australia
  1. Correspondence to Prof Ralph A Stewart, Green Lane Cardiovascular Service, Auckland City Hospital, Private Bag 92024, Auckland 1030, New Zealand; rstewart{at}


Objective Longer QRS duration on the ECG is associated with increased cardiovascular (CV) mortality. To evaluate potential mechanisms, we examined in this study the relationship between QRS duration and left ventricular (LV) mass and LV end systolic and end diastolic volume in patients with known CV disease or high-risk diabetes.

Methods In a substudy of the ONTARGET/TRANSCEND (Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial/Telmisartan Randomised Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease) clinical trials, 368 patients had a cardiac magnetic resonance scan to measure LV mass, LV end systolic volume, LV end diastolic volume and LV ejection fraction at baseline and after 2 years of follow-up. Relationships between QRS duration on the 12-lead ECG and LV mass and volumes were evaluated at both assessments.

Results Each 10-ms increase in QRS duration both within and above the normal reference range was associated with an 8.3% (95% CI 6.7% to 9.9%) increase in LV mass, a 9.2% (95% CI 7.4% to 10%) increase in LV end diastolic volume and a 7.8% (95% CI 6.4% to 9.3%) increase in LV end systolic volume. QRS duration increased with body size, but associations with LV mass and volumes remained strong after indexing measurements to height2.7 (p<0.001 for all) and were similar for subjects with an otherwise normal and abnormal ECG.

Conclusion A longer QRS duration both within and above the normal reference range is associated with a greater LV mass and larger LV end systolic and end diastolic volumes. This may explain the known association of longer QRS duration with increased CV mortality.

  • Electrocardiography
  • MRI
  • risk factors
  • cardiovascular diseases
  • left ventricular mass
  • coronary risk factors
  • aortic stenosis
  • mitral valve prolapse
  • mitral regurgitation
  • aortic valve disease
  • hypertension
  • antihypertensive drugs
  • ventricular hypertrophy

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  • Funding The ONTARGET/TRANSCEND cardiac MRI study was funded by the McMaster University, Hamilton, ON, Canada, and Boehringer Ingelheim, Ingelheim, Germany.

  • Competing interests Craig Anderson and Koon K Teo received consulting, lecture fees and research grants from Boehringer Ingelheim. Other authors have no conflicts of interests to declare.

  • Ethics approval Local authorities in Australia, Canada, Germany, Hong Kong and New Zealand.

  • Provenance and peer review Not commissioned; externally peer reviewed.