QRS duration and early hemodynamic instability after coronary revascularization surgery.
OBJECTIVE
The duration of the QRS interval measured by ECG is a marker of ventricular dysfunction and indicates a poor prognosis. Its value in patients undergoing coronary revascularization surgery has not been established.


METHODS
The study involved 203 consecutive patients (age 64+/-9 years, 74% male) scheduled for elective coronary surgery. The maximum QRS duration measured on a preoperative 12-lead ECG was recorded. Hemodynamic instability was defined as the occurrence of cardiac death, heart failure, or a need for intravenous inotropic drugs or intra-aortic balloon counterpulsation during the postoperative period.


RESULTS
The occurrence of hemodynamic instability (n=94, 46%) was associated with a longer preoperative QRS duration (97.5+/-21.14 ms vs 88.5+/-16.9 ms; P=.001). The QRS duration was also longer in patients who developed heart failure (n=23; 104.3+/-22.9 ms vs. 91.1+/-18.5 ms; P=.002), needed inotropic drugs (n=77; 96.5+/-20.5 ms vs. 90.1+/-18.2 ms; P=.007) or developed postoperative atrial fibrillation (n=58; 98.2+/-23.8 ms vs. 90.4+/-17.0 ms; P=.018). Bundle branch block was associated with a greater need for intra-aortic balloon counterpulsation (29% vs 12%; P=.012) or inotropic drugs (58% vs 35%; P=.014) and a higher incidence of hemodynamic instability (69% vs 42%; P=.006). Multivariate analysis identified the following independent predictors of hemodynamic instability: QRS duration (adjusted odds ratio [OR] per 10 ms=1.49; 95% confidence interval [CI], 1.11-2; P=.007), the lack of an arterial graft (OR=3.6; 95% CI, 1.14-11.6; P=.029) and extracorporeal circulation time (OR per min=1.013; 95% CI, 1.003-1.023; P=.013).


CONCLUSIONS
The intraventricular conduction delay, or QRS duration, was associated with a higher risk of postoperative hemodynamic instability following coronary surgery.
Arribas Leal
José M
JM
Servicio de Cirugía Cardiovascular, Hospital Universitario Virgen de la Arrixaca, Murcia, España. Arribasdelpeso@telepolis.com
Pascual-Figal
Domingo A
DA
Ahumada Vidal
Miguel
M
Marín Ortuño
Francisco
F
Gutiérrez García
Francisco
F
García-Puente del Corral
Julio
J
Ruipérez Abizanda
Juan A
JA
Torres Martínez
Ginés
G
Valdés Chávarri
Mariano
M
Arcas Meca
Ramón
R
D000368:Aged; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009204:Myocardial Revascularization; D011183:Postoperative Complications / Q000453:epidemiology* / Q000503:physiopathology*; D011379:Prognosis; D011446:Prospective Studies