title: Prognostic value of the QRS duration in patients with heart failure: a subgroup analysis from 24 centers of Val-HeFT.
abstract: BACKGROUND
  This study investigated whether QRS duration (QRS D) is a prognostic indicator in patients with heart failure (New York Heart Association [NYHA] classes II-IV).
  
  
  RESULTS
  This subgroup analysis included 248 patients with heart failure recruited in the German centers of the Valsartan Heart Failure Trial (Val-HeFT). Mean age was 60 years, mean NYHA class was 2.3, and mean left ventricular ejection fraction (EF) was 27.9%. Electrocardiograms were recorded and analyzed at the beginning of the study, at 2 weeks, 4 months, 1 year, and 2 years. The mean observation period for mortality was 25 months. Patients > or = 65 years and patients with an EF <20% had a significantly longer QRS D (P = .02; P = .0005). NYHA class, etiology of heart failure, therapy with angiotensin-converting enzyme inhibitors, amiodarone or beta-blockers, implanted defibrillator, and atrial fibrillation had no significant influence on QRS D. Total mortality was 9%: 14 patients died suddenly, 7 from heart failure, 2 from noncardiac causes. Kaplan-Meier plots show significantly different survival rates for patients with QRS D <120 ms, QRS D 120-159 ms, or QRS D > or = 160 ms (P = .0085). Multivariate analysis showed that QRS D was the only independent risk factor for all-cause mortality (P = .008). NYHA class, EF, atrial fibrillation, age, and gender failed to qualify as independent prognostic factors.
  
  
  CONCLUSIONS
  QRS duration in the surface electrocardiogram is an easily obtainable parameter with a significant prognostic impact in patients with congestive heart failure and a reduced EF. In this German subgroup of Val-HeFT patients, it was an independent predictor of all-cause mortality.
authors.affiliation: Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
authors.forename: Monika
authors.initials: M
authors.lastname: Hofmann
authors.forename: Ricarda
authors.initials: R
authors.lastname: Bauer
authors.forename: Renate
authors.initials: R
authors.lastname: Handrock
authors.forename: Gottfried
authors.initials: G
authors.lastname: Weidinger
authors.forename: Liselotte
authors.initials: L
authors.lastname: Goedel-Meinen
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D009202:Cardiomyopathies / Q000175:diagnosis / Q000503:physiopathology; D003327:Coronary Disease / Q000175:diagnosis / Q000503:physiopathology; D004311:Double-Blind Method; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D005858:Germany; D006329:Heart Conduction System / Q000503:physiopathology; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis