Prognostic Implication of QRS Variability during Hospitalization in Patients with Acute Decompensated Heart Failure.
OBJECTIVE
Heart failure (HF) patients display more varied QRS duration. We investigated whether QRS variability during hospitalization for acute decompensated HF is associated with poor clinical outcomes after discharge.


METHODS
One hundred seventy three patients (64% males; age 60±13 years) admitted for acute decompensated HF with severe left ventricular (LV) dysfunction (LV ejection fraction ≤35%) were consecutively enrolled. QRS variability was calculated by the difference between maximum and minimum QRS duration acquired during hospitalization. The prognostic implications on composite endpoints of death or urgent heart transplantation were analyzed.


RESULTS
Forty-two patients (24.3%) died and three patients (1.7%) underwent urgent heart transplantation during the follow-up of 51±18 months. Patients who reached composite endpoints (n=45) showed greater QRS variability than those who did not (n=128) (20±23 ms vs. 14±14 ms, p=0.046). Patients who had high QRS variability (more than 22 ms; n=36) tended to have a higher event rate than those with QRS variability <22 ms {39% vs. 23%, hazard ratio (HR), 1.88; 95% confidence interval (CI) 1.001-3.539, p=0.05}. Adjusting with other variables, high QRS variability was an independent predictor for composite outcome (HR 1.94; 95% CI 1.023-3.683, p=0.042).


CONCLUSIONS
QRS variability measured during hospitalization for acute decompensated HF has a prognostic impact in HF patients with severe LV dysfunction.
Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
So-Ryoung
SR
Lee
Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Eue-Keun
EK
Choi
Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Do-Yoon
DY
Kang
Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Myung-Jin
MJ
Cha
Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Youngjin
Y
Cho
Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
Il-Young
IY
Oh
Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Seil
S
Oh
Electrocardiography, variation; Heart decompensation; Heart failure; Prognosis