Predictive value of QRS complex duration in patients with chronic heart failure and atrial fibrillation: retrospective study

Cover Page

Cite item

Full Text

Abstract

Aim. To study of the features of the clinical course and prognosis in patients with chronic heart failure with low ejection fraction (HFrEF) and atrial fibrillation (AF) depending on the width of the QRS complex.

Materials and methods. We studied the case histories of 514 patients (aged 60.2±13.84 years, 78% men) with HFrEF, hospitalized at the Chazov National Medical Research Center of Cardiology (Moscow) for the period from Jan 1, 2017 to Dec 31, 2018. Patients were divided into 2 groups depending on the duration of the QRS complex.

Results. Clinical and statistical retrospective analysis of the medical histories of patients with HFrEF, depending on the QRS duration, showed the predominance of patients with a QRS complex size of less than 130 ms (60.7%). In HFrEF, the expansion of the QRS complex is accompanied by an increase in the rate of readmission in patients with sinus rhythm (p=0.004). In patients with AF, the rehospitalization rate is significantly higher than in sinus rhythm and does not depend on the QRS duration (p=0.001). The incidence of unfavorable outcomes increases in connection with the addition of AF, which is most likely a more significant risk factor than QRS width.

Conclusion. These results highlight that patients with AF and a narrow QRS complex have the same poor prognosis as those with a wide QRS complex and require the close attention of cardiologists.

About the authors

Tatiana M. Uskach

Chazov National Medical Research Center of Cardiology; Russian Medical Academy of Continuous Professional Education

Email: tuskach@mail.ru
ORCID iD: 0000-0003-4318-0315

д-р мед. наук, вед. науч. сотр. отд. заболеваний миокарда и сердечной недостаточности Института клинической кардиологии им. А.Л. Мясникова, проф. каф. кардиологии

Russian Federation, Moscow; Moscow

Yulduz Sh. Sharapova

Chazov National Medical Research Center of Cardiology

Author for correspondence.
Email: yulduzsharapova@mail.ru
ORCID iD: 0000-0003-4767-198X

аспирант отд. заболеваний миокарда и сердечной недостаточности Института клинической кардиологии им. А.Л. Мясникова

Russian Federation, Moscow

Alfiya A. Safiullina

Email: a_safiulina@mail.ru
ORCID iD: 0000-0003-3483-4698

канд. мед. наук, науч. сотр. отд. заболеваний миокарда и сердечной недостаточности Института клинической кардиологии им. А.Л. Мясникова

Russian Federation

Ekaterina V. Zinovyeva

Chazov National Medical Research Center of Cardiology

Email: ryabysh@gmail.com
ORCID iD: 0000-0003-1531-649X

канд. мед. наук, зав. отд. организации оказания медицинской помощи и статистики Института клинической кардиологии им. А.Л. Мясникова

Russian Federation, Moscow

Sergey N. Tereshchenko

Chazov National Medical Research Center of Cardiology; Russian Medical Academy of Continuous Professional Education

Email: stereschenko@yandex.ru
ORCID iD: 0000-0001-9234-6129

д-р мед. наук, проф., рук. отд. заболеваний миокарда и сердечной недостаточности Института клинической кардиологии им. А.Л. Мясникова, зав. каф. кардиологии

Russian Federation, Moscow; Moscow

References

  1. Savarese G, Lund LH. Global Public Health Burden of Heart Failure. Card Fail Rev. 2017;3(1):7-11. doi: 10.15420/cfr.2016:25:2
  2. Mosterd A, Hoes AW. Clinical epidemiology of heart failure. Heart. 2007;93(9):1137-46. doi: 10.1136/hrt.2003.025270
  3. Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics – 2012 update: a report from the American Heart Association [published correction appears in Circulation]. Circulation. 2012;125(1):e2-e220. doi: 10.1161/CIR.0b013e31823ac046
  4. Kotecha D, Piccini JP. Atrial fibrillation in heart failure: what should we do? Eur Heart J. 2015;36(46):3250-7. doi: 10.1093/eurheartj/ehv513
  5. Dhingra R, Ho Nam B, Benjamin EJ, et al. Cross-sectional relations of electrocardiographic QRS duration to left ventricular dimensions: the Framingham Heart Study. J Am Coll Cardiol. 2005;45(5):685-9. doi: 10.1016/j.jacc.2004.11.046
  6. Ruschitzka F, Abraham WT, Singh JP, et al. Cardiac-resynchronization therapy in heart failure with a narrow QRS complex. N Engl J Med. 2013;369(15):1395-405. doi: 10.1056/NEJMoa1306687
  7. Maisel WH, Stevenson LW. Atrial fibrillation in heart failure: epidemiology, pathophysiology, and rationale for therapy. Am J Cardiol. 2003;91(6A):2D-8D. doi: 10.1016/s0002-9149(02)03373-8
  8. Bleeker GB, Holman ER, Steendijk P, et al. Cardiac resynchronization therapy in patients with a narrow QRS complex. J Am Coll Cardiol. 2006;48(11):2243-50. doi: 10.1016/j.jacc.2006.07.067
  9. Tayal B, Gorcsan J 3rd, Bax JJ, et al. Cardiac Resynchronization Therapy in Patients With Heart Failure and Narrow QRS Complexes. J Am Coll Cardiol. 2018;71(12):1325-33. doi: 10.1016/j.jacc.2018.01.042
  10. McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599-726. doi: 10.1093/eurheartj/ehab368
  11. Lund LH, Jurga J, Edner M, et al. Prevalence, correlates, and prognostic significance of QRS prolongation in heart failure with reduced and preserved ejection fraction. Eur Heart J. 2013;34(7):529-39. doi: 10.1093/eurheartj/ehs305
  12. Orso F, Fabbri G, Maggioni AP. Epidemiology of Heart Failure. Handb Exp Pharmacol. 2017;243:15-33. doi: 10.1007/164_2016_74
  13. Терещенко С.Н., Романова Н.В., Жиров И.В., и др. Российский регистр больных хронической сердечной недостаточностью и фибрилляцией предсердий (РИФ-ХСН): клинико-демографические характеристики выборки на момент включения в регистр. Сердечная недостаточность. 2016;17(6):418-26. [Tereshchenko SN, Romanova NV, Zhirov IV, et al. Russian Registry of Patients with Chronic Heart Failure and Atrial Fibrillation (RIF-CHF): Clinical and demographic characteristics of the sample upon inclusion into the Registry. Serdechnaia Nedostatochnost'. 2016;17(6):418-26 (in Russian)]. doi: 10.18087/RHFJ.2016.6.2276
  14. Nieminen MS, Brutsaert D, Dickstein K, et al. EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population. Eur Heart J. 2006;27(22):2725-36. doi: 10.1093/eurheartj/ehl193
  15. Maggioni AP, Dahlstrom U, Filippatos G, et al. EURObservational Research Programme: the Heart Failure Pilot Survey (ESC-HF Pilot). Eur J Heart Fail. 2010;12(10):1076-84. doi: 10.1093/eurjhf/hfq154
  16. Follath F, Yilmaz MB, Delgado JF, et al. Clinical presentation, management and outcomes in the Acute Heart Failure Global Survey of Standard Treatment (ALARM-HF). Intensive Care Med. 2011;37(4):619-26. doi: 10.1007/s00134-010-2113-0
  17. Ghio S, Constantin C, Klersy C, et al. Interventricular and intraventricular dyssynchrony are common in heart failure patients, regardless of QRS duration. Eur Heart J. 2004;25(7):571-8. doi: 10.1016/j.ehj.2003.09.030
  18. Bleeker GB, Yu CM, Nihoyannopoulos P, et al. Optimal use of echocardiography in cardiac resynchronisation therapy. Heart. 2007;93(11):1339-50. doi: 10.1136/hrt.2005.076422
  19. Moe GW. B-type natriuretic peptide in heart failure. Curr Opin Cardiol. 2006;21(3):208-14. doi: 10.1097/01.hco.0000221582.71619.84
  20. Maisel AS, Duran JM, Wettersten N. Natriuretic Peptides in Heart Failure: Atrial and B-type Natriuretic Peptides. Heart Fail Clin. 2018;14(1):13-25. doi: 10.1016/j.hfc.2017.08.002
  21. Raphael CE, Whinnett ZI, Davies JE, et al. Quantifying the paradoxical effect of higher systolic blood pressure on mortality in chronic heart failure. Heart. 2009;95(1):56-62. doi: 10.1136/hrt.2007.134973
  22. McMurray JJ, Packer M, Desai AS, et al. Dual angiotensin receptor and neprilysin inhibition as an alternative to angiotensin-converting enzyme inhibition in patients with chronic systolic heart failure: rationale for and design of the Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure trial (PARADIGM-HF). Eur J Heart Fail. 2013;15(9):1062-73. doi: 10.1093/eurjhf/hft052
  23. Krum H, Massie B, Abraham WT, et al. Direct renin inhibition in addition to or as an alternative to angiotensin converting enzyme inhibition in patients with chronic systolic heart failure: rationale and design of the Aliskiren Trial to Minimize OutcomeS in Patients with HEart failuRE (ATMOSPHERE) study. Eur J Heart Fail. 2011;13(1):107-14. doi: 10.1093/eurjhf/hfq212
  24. Weng LC, Preis SR, Hulme OL, et al. Genetic Predisposition, Clinical Risk Factor Burden, and Lifetime Risk of Atrial Fibrillation. Circulation. 2018;137(10):1027-38. doi: 10.1161/CIRCULATIONAHA.117.031431
  25. Roger VL. Epidemiology of heart failure. Circ Res. 2013;113(6):646-59. doi: 10.1161/CIRCRESAHA.113.300268
  26. Chioncel O, Lainscak M, Seferovic PM, et al. Epidemiology and one-year outcomes in patients with chronic heart failure and preserved, mid-range and reduced ejection fraction: an analysis of the ESC Heart Failure Long-Term Registry. Eur J Heart Fail. 2017;19(12):1574-85. doi: 10.1002/ejhf.813
  27. Zafrir B, Lund LH, Laroche C, et al. Prognostic implications of atrial fibrillation in heart failure with reduced, mid-range, and preserved ejection fraction: a report from 14 964 patients in the European Society of Cardiology Heart Failure Long-Term Registry. Eur Heart J. 2018;39(48):4277-84. doi: 10.1093/eurheartj/ehy626
  28. Conrad N, Judge A, Tran J, et al. Temporal trends and patterns in heart failure incidence: a population-based study of 4 million individuals. Lancet. 2018;391(10120):572-80. doi: 10.1016/S0140-6736(17)32520-5
  29. Gerber Y, Weston SA, Redfield MM, et al. A contemporary appraisal of the heart failure epidemic in Olmsted County, Minnesota, 2000 to 2010. JAMA Intern Med. 2015;175(6):996-1004. doi: 10.1001/jamainternmed.2015.0924

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Study design (distribution of patients).

Download (79KB)
Indexing metadata
3. Fig. 2. Histogram of QRS width (ms).

Download (92KB)
Indexing metadata
4. Fig. 3. Frequency of rehospitalization in groups depending on the duration of the QRS complex.

Download (97KB)
Indexing metadata
5. Fig. 4. Patient survival (Kaplan–Mayer curves) depending on the width of the QRS complex: (a) in patients with AF, (b) in patients without AF.

Download (184KB)
Indexing metadata

Copyright (c) 2022 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 
 


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies