Association of QRS duration with left ventricular structure and function and risk of heart failure in middle-aged and older adults: the Multi-Ethnic Study of Atherosclerosis (MESA).
OBJECTIVE
Prolonged QRS duration (QRSd) on the electrocardiogram (ECG) has been associated with cardiac structural and functional abnormalities by echocardiography and an increased risk of heart failure (HF). Data are sparse on these relationships in middle-aged and elderly individuals free of baseline cardiovascular disease with respect to cardiac magnetic resonance imaging (MRI). We sought to determine whether QRSd is associated with incident HF and measures of cardiac structure and function by cardiac MRI.


RESULTS
We analysed baseline ECGs in the Multi-Ethnic Study of Atherosclerosis (MESA) to determine whether QRSd >100 ms was associated with incident HF. We adjusted for demographic and clinical risk factors, as well as MRI measures of left ventricular (LV) structure and function. Among 4591 eligible participants (51% women; 39% white; mean age 61 years), 75 developed incident HF over a mean follow-up of 7.1 years. QRSd >100 ms was significantly associated with MRI measures of cardiac structure and function, as well as incident HF, even after adjustment for demographic covariates [hazard ratio (HR) 2.10, 95% confidence interval (CI) 1.29-3.42; P = 0.003] and clinical risk factors (HR 1.86, 95% CI 1.14-3.03; P = 0.01). With further adjustment for individual LV structural measures, findings were attenuated to non-significance. Separate adjustment for LV functional measures yielded only mild attenuation.


CONCLUSIONS
In middle-aged and older adults without cardiovascular disease, a QRSd >100 ms was significantly associated with incident HF. After adjustment for LV structural measures, the association was attenuated to non-significance, suggesting that prolonged QRSd is potentially a useful marker of LV structure that may predispose to HF risk.
Department of Medicine, Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA. l-ilkhanoff@northwestern.edu
Leonard
L
Ilkhanoff
Kiang
K
Liu
Hongyan
H
Ning
Saman
S
Nazarian
David A
DA
Bluemke
Elsayed Z
EZ
Soliman
Donald M
DM
Lloyd-Jones
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D015331:Cohort Studies; D016001:Confidence Intervals; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000208:ethnology* / Q000473:pathology; D004562:Electrocardiography; D005006:Ethnicity; D005260:Female; D006305:Health Status Indicators; D006333:Heart Failure / Q000453:epidemiology* / Q000208:ethnology / Q000473:pathology; D006352:Heart Ventricles / Q000473:pathology*; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment / Q000379:methods; D013997:Time Factors; D014481:United States / Q000453:epidemiology