Relation of Increasing QRS Duration Over Time and Cardiovascular Events in Outpatients With Heart Failure Journal Articles uri icon

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  • An increase in the duration of the QRS complex over time has been shown to be associated with poor clinical outcomes in specific subgroups of heart failure (HF) patients. There is a paucity of data on the clinical impact of increasing QRS duration on outcomes in HF with narrow QRS duration. This was a retrospective study of consecutive adult referrals to a tertiary outpatient HF clinic over a 2-year period. All patients with a narrow QRS, (<130 ms) were included. The primary outcome was mortality. Secondary outcomes were HF hospitalization and a composite of HF hospitalization, implantation of cardiac resynchronization therapy or left ventricular assist device and cardiac transplant. A total of 253 patients with 2 or more QRS measurments were included. Death occurred in 41 patients (16%), 258 HF hospitalizations occurred in 116 patients (46%) and the composite occurred in 127 patients (50%). Multivariable analyses found that a rate of QRS duration change of ≥1 ms/month was independently associated with increased mortality (odds ratio [OR] 2.26, 95% confidence interval [CI] 1.04 to 4.91), HF hospitalization (relative risk [RR] 2.01, 95% CI 1.37 to 2.94), and the composite (OR 2.40, 95%CI 1.44 to 4.02). A new QRS >130 ms was also independently associated with mortality (OR 3.27, 95%CI 1.29-8.32), HF hospitalization (RR 2.75, 95% CI 1.72 to 4.4) and the composite (OR 2.52, 95%CI 1.27 to 4.99). In conclusion, in patients with HF and a narrow baseline QRS, an increase in QRS duration of ≥1 ms per month is associated with increased mortality and HF hospitalization. HF patients may benefit from serial monitoring of QRS duration.


  • Alfraidi, Hassan
  • Seifer, Colette M
  • Hiebert, Brett M
  • Torbiak, Lindsay
  • Zieroth, Shelley
  • McIntyre, William

publication date

  • December 2019

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