title: Prolonged electrocardiogram QRS duration independently predicts long-term mortality in patients hospitalized for heart failure with preserved systolic function.
abstract: BACKGROUND
  Prolonged electrocardiogram (ECG) QRS duration (>or=120 ms) is a risk factor for death in systolic heart failure, but its effects in heart failure with preserved systolic function (HFPSF) have not been extensively studied. We hypothesized that prolonged ECG QRS duration would independently predict long-term mortality in hospitalized HFPSF patients.
  
  
  RESULTS
  We analyzed 872 HFPSF patients (defined as left ventricular ejection fraction >or=50%) admitted to Michigan community hospitals between 2002 and 2004 and followed for a median of 660 days. We used Cox proportional hazards models to assess mortality hazard for prolonged QRS duration (>or=120 ms) on the last available predischarge ECG, first on a univariable basis and then after multivariable adjustment for other known risk factors. Prolonged QRS duration increased univariable all-cause mortality (HR 1.71; 95% CI 1.33-2.19, P < .001) and after multivariable adjustment (HR 1.31; 95% CI 1.01-1.71, P=.04). The univariable effect size was larger in younger patients. In multivariable models, there was no significant interaction between prolonged QRS and age, hypertension, or coronary artery disease status.
  
  
  CONCLUSIONS
  Prolonged QRS duration (>or=120 ms) on a predischarge ECG is an independent and consistent predictor of long-term mortality in hospitalized HFPSF patients.
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA. scothumm@med.umich.edu
authors.forename: Scott L
authors.initials: SL
authors.lastname: Hummel
authors.forename: Stephen
authors.initials: S
authors.lastname: Skorcz
authors.forename: Todd M
authors.initials: TM
authors.lastname: Koelling
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000401:mortality* / Q000503:physiopathology; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008133:Long QT Syndrome / Q000150:complications / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015996:Survival Rate / Q000639:trends; D013599:Systole / Q000502:physiology; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology*
references.citation: Circulation. 1997 Jun 17;95(12):2660-7
references.pmid: 9193435
references.citation: JAMA. 2008 Jun 11;299(22):2656-66
references.pmid: 18544725
references.citation: J Am Coll Cardiol. 2007 Feb 13;49(6):687-94
references.pmid: 17291934
references.citation: Am J Cardiol. 2006 Jan 15;97(2):256-9
references.pmid: 16442374
references.citation: Am J Cardiol. 2003 Jun 1;91(11):1375-8
references.pmid: 12767441
references.citation: Circulation. 2000 May 2;101(17):2118-21
references.pmid: 10790356
references.citation: JAMA. 2006 Nov 8;296(18):2217-26
references.pmid: 17090768
references.citation: J Am Coll Cardiol. 2005 Jul 5;46(1):51-6
references.pmid: 15992635
references.citation: J Card Fail. 2005 Apr;11(3):177-87
references.pmid: 15812744
references.citation: Eur Heart J. 2008 Feb;29(3):339-47
references.pmid: 18156618
references.citation: Am J Med. 1977 May;62(5):677-86
references.pmid: 871125
references.citation: Heart. 2001 Sep;86(3):343-9
references.pmid: 11514495
references.citation: N Engl J Med. 2006 Jul 20;355(3):251-9
references.pmid: 16855265
references.citation: Circulation. 2006 Aug 1;114(5):397-403
references.pmid: 16864724
references.citation: J Am Coll Cardiol. 2007 Jan 2;49(1):88-96
references.pmid: 17207727
references.citation: Medicine (Baltimore). 2004 Nov;83(6):315-334
references.pmid: 15525844
references.citation: J Am Coll Cardiol. 2006 Jan 3;47(1):76-84
references.pmid: 16386668
references.citation: Prog Cardiovasc Dis. 2005 Mar-Apr;47(5):314-9
references.pmid: 16003646
references.citation: Eur J Echocardiogr. 2006 Oct;7(5):373-8
references.pmid: 16337208
references.citation: J Am Coll Cardiol. 2007 Jan 2;49(1):97-105
references.pmid: 17207728
references.citation: J Cardiovasc Electrophysiol. 2007 Dec;18(12):1231-5
references.pmid: 17883404
references.citation: J Am Coll Cardiol. 1991 Aug;18(2):377-82
references.pmid: 1856405
references.citation: J Card Fail. 2006 Feb;12(1):e1-2
references.pmid: 16500560
references.citation: Cardiovasc Drugs Ther. 1996 Nov;10(5):495-510
references.pmid: 8950063
references.citation: Heart Rhythm. 2006 Mar;3(3):313-6
references.pmid: 16500304
references.citation: Am Heart J. 2002 Mar;143(3):398-405
references.pmid: 11868043
references.citation: Am J Med. 2001 Mar;110(4):253-9
references.pmid: 11239842
references.citation: Am J Cardiol. 2007 Aug 1;100(3):503-6
references.pmid: 17659936
references.citation: J Am Coll Cardiol. 2005 Oct 4;46(7):1242-8
references.pmid: 16198838
references.citation: JAMA. 2003 Nov 19;290(19):2581-7
references.pmid: 14625335
references.citation: J Am Coll Cardiol. 2008 Jan 1;51(1):12-7
references.pmid: 18174030
references.citation: J Am Coll Cardiol. 2005 Mar 1;45(5):685-9
references.pmid: 15734611
references.citation: N Engl J Med. 2005 Apr 14;352(15):1539-49
references.pmid: 15753115
references.citation: J Am Coll Cardiol. 2005 Dec 20;46(12):2237-43
references.pmid: 16360052
references.citation: Am J Cardiol. 2000 Oct 15;86(8):863-7
references.pmid: 11024402
references.citation: N Engl J Med. 2006 Jul 20;355(3):260-9
references.pmid: 16855266
references.citation: Lancet. 2003 Sep 6;362(9386):777-81
references.pmid: 13678871
references.citation: J Cardiovasc Electrophysiol. 2004 May;15(5):544-9
references.pmid: 15149423
references.citation: J Am Coll Cardiol. 1997 Oct;30(4):1046-51
references.pmid: 9316537
references.citation: J Am Coll Cardiol. 2001 Dec;38(7):2101-13
references.pmid: 11738322
references.citation: J Am Coll Cardiol. 1998 Aug;32(2):476-82
references.pmid: 9708478
references.citation: Circulation. 2006 Mar 21;113(11):1424-33
references.pmid: 16534009
references.citation: Am Heart J. 2007 Aug;154(2):278-84
references.pmid: 17643577
references.citation: Chest. 2002 Aug;122(2):528-34
references.pmid: 12171827