title: Electrocardiography and Doppler echocardiography for risk stratification in patients with chronic heart failure: incremental prognostic value of QRS duration and a restrictive mitral filling pattern.
abstract: OBJECTIVE
  This prospective study tested whether Doppler echocardiographic variables add incremental value to QRS duration in determining the prognosis of patients with chronic heart failure (CHF) and systolic dysfunction.
  
  
  BACKGROUND
  Diastolic dysfunction frequently is observed in patients with CHF, but its prognostic impact relative to that of QRS duration is unknown.
  
  
  METHODS
  A total of 193 patients with CHF and an ejection fraction <45% were enrolled prospectively. Echo measurements included left ventricular dimensions/volumes, ejection fraction, mitral early/late diastolic velocity ratio, deceleration time, and tissue Doppler mitral annular velocities. The mitral filling pattern was classified as either restrictive (RFP) or nonrestrictive. A cardiac event (cardiac death or urgent cardiac transplantation) was defined as combined study end point.
  
  
  RESULTS
  During a follow-up of 385 +/- 270 days, 24 patients suffered an event (cardiac death, n = 21; urgent transplantation, n = 3). The RFP, QRS duration, left ventricular systolic diameter, and mitral annular early diastolic velocity were independent predictors of an event. In patients with QRS duration >144 ms, the outcome was markedly poorer in the presence of RFPs as compared with their absence. Similarly, despite a QRS duration <or =144 ms, the outcome was worse in the presence of a RFP. A risk-stratification model based on the three strongest independent predictors separated groups into those with good prognosis and those with high, intermediate, and low event-free survival rates.
  
  
  CONCLUSIONS
  In subjects with CHF and systolic dysfunction, transmitral flow patterns add incremental value to QRS duration in determining the prognosis.
authors.affiliation: Department of Cardiology and Angiology, University Hospital of Münster, Albert-Schweitzer-Strasse 33, D-48129 Münster, Germany. bruchc@uni-muenster.de
authors.forename: Christian
authors.initials: C
authors.lastname: Bruch
authors.forename: Michael
authors.initials: M
authors.lastname: Gotzmann
authors.forename: Jörg
authors.initials: J
authors.lastname: Stypmann
authors.forename: Frauke
authors.initials: F
authors.lastname: Wenzelburger
authors.forename: Markus
authors.initials: M
authors.lastname: Rothenburger
authors.forename: Matthias
authors.initials: M
authors.lastname: Grude
authors.forename: Hans H
authors.initials: HH
authors.lastname: Scheld
authors.forename: Lars
authors.initials: L
authors.lastname: Eckardt
authors.forename: Günter
authors.initials: G
authors.lastname: Breithardt
authors.forename: Thomas
authors.initials: T
authors.lastname: Wichter
mesh_terms: D002908:Chronic Disease; D018572:Disease-Free Survival; D015150:Echocardiography, Doppler / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005858:Germany / Q000453:epidemiology; D006329:Heart Conduction System / Q000503:physiopathology; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D012720:Severity of Illness Index; D016019:Survival Analysis