The relation of bundle branch block (BBB) with adverse outcome is controversial. We
hypothesized that increased QRS duration is an independent predictor of cardiovascular
(CV) mortality in a cross-sectional US population. This is a retrospective cohort
study on prospectively collected data to assess the relationship between QRS duration
on routine ECG and CV mortality. Participants included 8,527 patients with ECG data
available from the National Health and Nutrition Examination Survey data set, representing
74,062,796 individuals in the United States. Mean age was 60.5 ± 13.6 years. Most
subjects were white (87%) and women (53%). During the follow-up period of 106,244.6
person-years, 1,433 CV deaths occurred. Multivariate analysis revealed that the highest
quartile of QRS duration was associated with higher CV mortality than lowest quartile
(hazard ratio [HR] 1.3, 95% confidence interval [CI] 1.01 to 1.7, p = 0.04) after
adjustment for established risk factors. Both left BBB (HR 2.4, 95% CI 1.3 to 4.7,
p = 0.009) and right BBB (HR 1.90, 95% CI 1.2 to 3.0, p = 0.008) were significantly
associated with increased CV mortality. The addition of the QRS duration in 10-millisecond
increments to the Framingham Risk Score model resulted in 4.4% overall net reclassification
improvement (95% CI 0.02 to 0.04; p = 0.00006). In conclusion, increased QRS duration
was found to be an independent predictor of CV mortality in this cross-sectional US
population. A model including QRS duration in addition to traditional risk factors
was associated with improved CV risk prediction.
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Article Info
Publication History
Published online: May 31, 2013
Accepted:
April 22,
2013
Received in revised form:
April 22,
2013
Received:
March 4,
2013
Footnotes
Drs. Badheka, Singh, and Patel contributed equally to this work.
See page 676 for disclosure information.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
