Chest
Volume 122, Issue 2, August 2002, Pages 528-534
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Clinical Investigations
CARDIOLOGY
Congestive Heart Failure and QRS Duration: Establishing Prognosis Study

https://doi.org/10.1378/chest.122.2.528Get rights and content

Study objectives

There is a lack of epidemiologic information about duration of QRS complex in the general heart failure population. We sought to describe age, sex, and clinical subset specific prevalence of QRS prolongation in this population.

Methods

Data were abstracted from the Resource Utilization Among Congestive Heart Failure Study, which identified 29,686 patients with heart failure from a large, mixed-model managed-care organization during 1989 to 1999. A target population of 3,471 had echocardiographic data and ECG data obtained from automated sources during the first year of diagnosis. Systolic dysfunction was defined as heart failure plus a left ventricular ejection fraction < 45%.

Measurements and results

Among the heart failure population, 20.8% of the subjects had a QRS duration ≥ 120 ms. A total of 425 men (24.7%) and 296 women (16.9%) had a prolonged QRS duration (p < 0.01). There was a linear relationship between increased QRS duration and decreased ejection fraction (p < 0.01). A prolonged QRS duration of 120 to 149 ms demonstrated increased mortality at 60 months (p = 0.001), when adjusted for age, sex, and race (p = 0.001). Systolic dysfunction was associated with graded increases in mortality across ascending levels of QRS prolongation.

Conclusions

Approximately 20% of a generalized heart failure population can be expected to have a prolonged QRS duration within the first year of diagnosis, suggesting that as many as 20% of patients with heart failure may be candidates for biventricular pacing.

Section snippets

Setting

The target population was derived from the Resource Utilization Among Congestive Heart Failure (REACH) study, which has been recently reported.23 Briefly, Henry Ford Hospital is a 903-bed tertiary care center located in the Detroit metropolitan area and receives patients whose care is provided primarily within the Henry Ford Health System (HFHS), a vertically integrated, mixed-model managed-care organization that includes urban and suburban satellite clinics in Southeast Michigan. The CONQUEST

Baseline Characteristics

The target population of 3,471 patients with echocardiographic and ECG data were followed up for an average of 32.4 months (Table 1). The average index age was 66.1 years, with 1,723 men (49.6%), 1,748 women (50.4%), 1,429 white subjects (41.2%), and 1,925 black subjects (55.5%). The average QRS duration of the population was 104 ms, and 721 patients were identified with a QRS duration ≥ 120 ms. Overall, there were 1,798 deaths (51.8%).

Epidemiology of QRS Prolongation

The prevalence of systolic dysfunction was analyzed for

Discussion

This study highlights the determinants and utility of QRS duration in the general CHF population. In a prior data validation set, the positive predictive value of the ICD-9-CM coding was 73.8% when chart analysis was performed using both Framingham criteria and National Health and Nutritional Examination Survey-I criteria for CHF.2829 This is similar to the positive predictive value found in a previously published report.30 The most common cause of CHF in this set was caused by ischemic causes,

Conclusion

A prolonged QRS duration can be expected in 20% of a generalized heart failure population. Determinants for a prolonged QRS duration are male sex, white race, elderly age groups, and patients with systolic dysfunction. When compared with patients with a normal QRS duration, those patients with the most extreme QRS prolongation have improved survival, whereas patients with intermediate prolongation of the QRS complex (120 to 149 ms) have worse survival. Also, systolic dysfunction seems to have a

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