Advertisement

Eight-Year Prognostic Value of QRS Duration in Patients With Known or Suspected Coronary Artery Disease Referred for Myocardial Perfusion Imaging

      QRS duration is of prognostic relevance in patients with several underlying heart diseases. Short-term data also show the prognostic value of QRS duration in lower risk groups of patients. The aim of this study was to investigate the long-term prognostic value of QRS duration in patients with known or suspected coronary artery disease. The study cohort consisted of 512 patients (308 men, mean age 60 ± 11 years) who underwent myocardial perfusion imaging (MPI) for the evaluation of suspected or known coronary artery disease. Follow-up data were collected to assess the prognostic value of QRS duration, alongside clinical characteristics and MPI results. End points were cardiac death and cardiac death or nonfatal myocardial infarction (MI). During a mean follow-up of 8.6 ± 5.2 years, 290 patients (60%) died, with 139 deaths (27%) attributable to cardiac causes. Nonfatal MI occurred in 28 patients (6%), and 127 patients (25%) underwent late coronary revascularization (>3 months). Patients with QRS duration <120 ms had annualized cardiac death rates and cardiac death or nonfatal MI rates of 2.2% and 2.3%, respectively, compared with those of 4.1% and 4.4% in patients with QRS duration ≥120 ms. Multivariate models identified QRS duration ≥120 ms as an independent predictor of both end points, on top of clinical characteristics and MPI results. In conclusion, QRS duration ≥120 ms is an independent predictor of cardiac death and cardiac death or nonfatal MI, after adjustment for clinical characteristics and MPI results.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Lund L.H.
        • Jurga J.
        • Edner M.
        • Benson L.
        • Dahlstrom U.
        • Linde C.
        • Alehagen U.
        Prevalence, correlates, and prognostic significance of QRS prolongation in heart failure with reduced and preserved ejection fraction.
        Eur Heart J. 2013; 34: 529-539
        • Park H.S.
        • Kim H.
        • Park J.H.
        • Han S.
        • Yoo B.S.
        • Shin M.S.
        • Seong I.W.
        • Ahn Y.
        • Kang S.M.
        • Kim J.J.
        • Jeon E.S.
        • Cho M.C.
        • Choi D.J.
        • Chae S.C.
        • Kim Y.J.
        • Seo H.S.
        • Oh B.H.
        • Lee M.M.
        • Ryu K.H.
        QRS prolongation in the prediction of clinical cardiac events in patients with acute heart failure: analysis of data from the Korean Acute Heart Failure Registry.
        Cardiology. 2013; 125: 96-103
        • Silvet H.
        • Amin J.
        • Padmanabhan S.
        • Pai R.G.
        Prognostic implications of increased QRS duration in patients with moderate and severe left ventricular systolic dysfunction.
        Am J Cardiol. 2001; 88 (a186): 182-185
        • Baslaib F.
        • Alkaabi S.
        • Yan A.T.
        • Yan R.T.
        • Dorian P.
        • Nanthakumar K.
        • Casanova A.
        • Goodman S.G.
        QRS prolongation in patients with acute coronary syndromes.
        Am Heart J. 2010; 159: 593-598
        • Whitbeck M.G.
        • Charnigo R.J.
        • Shah J.
        • Morales G.
        • Leung S.W.
        • Fornwalt B.
        • Bailey A.L.
        • Ziada K.
        • Sorrell V.L.
        • Zegarra M.M.
        • Thompson J.
        • Hosn N.A.
        • Campbell C.L.
        • Gurley J.
        • Anaya P.
        • Booth D.C.
        • Di Biase L.
        • Natale A.
        • Smyth S.
        • Moliterno D.J.
        • Elayi C.S.
        QRS duration predicts death and hospitalization among patients with atrial fibrillation irrespective of heart failure: evidence from the AFFIRM study.
        Europace. 2014; 16: 803-811
        • Aro A.L.
        • Anttonen O.
        • Tikkanen J.T.
        • Junttila M.J.
        • Kerola T.
        • Rissanen H.A.
        • Reunanen A.
        • Huikuri H.V.
        Intraventricular conduction delay in a standard 12-lead electrocardiogram as a predictor of mortality in the general population.
        Circ Arrhythm Electrophysiol. 2011; 4: 704-710
        • Kurl S.
        • Makikallio T.H.
        • Rautaharju P.
        • Kiviniemi V.
        • Laukkanen J.A.
        Duration of QRS complex in resting electrocardiogram is a predictor of sudden cardiac death in men.
        Circulation. 2012; 125: 2588-2594
        • Badheka A.O.
        • Singh V.
        • Patel N.J.
        • Deshmukh A.
        • Shah N.
        • Chothani A.
        • Mehta K.
        • Grover P.
        • Savani G.T.
        • Gupta S.
        • Rathod A.
        • Marzouka G.R.
        • Mitrani R.D.
        • Moscucci M.
        • Cohen M.G.
        QRS duration on electrocardiography and cardiovascular mortality (from the National Health and Nutrition Examination Survey-III).
        Am J Cardiol. 2013; 112: 671-677
        • Schinkel A.F.L.
        • Elhendy A.
        • van Domburg R.T.
        • Biagini E.
        • Rizzello V.
        • Veltman C.E.
        • ten Kate G.L.
        • Sijbrands E.J.
        • Akkerhuis K.M.
        • Geleijnse M.L.
        • ten Cate F.J.
        • Simoons M.L.
        • Bax J.J.
        • Poldermans D.
        Prognostic significance of QRS duration in patients with suspected coronary artery disease referred for noninvasive evaluation of myocardial ischemia.
        Am J Cardiol. 2009; 104: 1490-1493
        • Elhendy A.
        • Hammill S.C.
        • Mahoney D.W.
        • Pellikka P.A.
        Relation of QRS duration on the surface 12-lead electrocardiogram with mortality in patients with known or suspected coronary artery disease.
        Am J Cardiol. 2005; 96: 1082-1088
        • Goodyear M.D.
        • Krleza-Jeric K.
        • Lemmens T.
        The Declaration of Helsinki.
        Br Med J. 2007; 335: 624-625
        • Surawicz B.
        • Childers R.
        • Deal B.J.
        • Gettes L.S.
        • Bailey J.J.
        • Gorgels A.
        • Hancock E.W.
        • Josephson M.
        • Kligfield P.
        • Kors J.A.
        • Macfarlane P.
        • Mason J.W.
        • Mirvis D.M.
        • Okin P.
        • Pahlm O.
        • Rautaharju P.M.
        • van Herpen G.
        • Wagner G.S.
        • Wellens H.
        AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: Part III: intraventricular conduction disturbances: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology.
        J Am Coll Cardiol. 2009; 53: 976-981
        • Elhendy A.
        • Valkema R.
        • van Domburg R.T.
        • Bax J.J.
        • Nierop P.R.
        • Cornel J.H.
        • Geleijnse M.L.
        • Reijs A.E.M.
        • Krenning E.P.
        • Roelandt J.R.T.C.
        Safety of dobutamine-atropine stress myocardial perfusion scintigraphy.
        J Nucl Med. 1998; 39: 1662-1666