title: Ventricular conduction and long-term heart failure outcomes and mortality in African Americans: insights from the Jackson Heart Study.
abstract: BACKGROUND
  QRS prolongation is associated with adverse outcomes in mostly white populations, but its clinical significance is not well established for other groups. We investigated the association between QRS duration and mortality in African Americans.
  
  
  RESULTS
  We analyzed data from 5146 African Americans in the Jackson Heart Study stratified by QRS duration on baseline 12-lead ECG. We defined QRS prolongation as QRS≥100 ms. We assessed the association between QRS duration and all-cause mortality using Cox proportional hazards models and reported the cumulative incidence of heart failure hospitalization. We identified factors associated with the development of QRS prolongation in patients with normal baseline QRS. At baseline, 30% (n=1528) of participants had QRS prolongation. The cumulative incidences of mortality and heart failure hospitalization were greater with versus without baseline QRS prolongation: 12.6% (95% confidence interval [CI], 11.0-14.4) versus 7.1% (95% CI, 6.3-8.0) and 8.2% (95% CI, 6.9-9.7) versus 4.4% (95% CI, 3.7-5.1), respectively. After risk adjustment, QRS prolongation was associated with increased mortality (hazard ratio, 1.27; 95% CI, 1.03-1.56; P=0.02). There was a linear relationship between QRS duration and mortality (hazard ratio per 10 ms increase, 1.06; 95% CI, 1.01-1.12). Older age, male sex, prior myocardial infarction, lower ejection fraction, left ventricular hypertrophy, and left ventricular dilatation were associated with the development of QRS prolongation.
  
  
  CONCLUSIONS
  QRS prolongation in African Americans was associated with increased mortality and heart failure hospitalization. Factors associated with developing QRS prolongation included age, male sex, prior myocardial infarction, and left ventricular structural abnormalities.
authors.affiliation: From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.). robert.mentz@duke.edu.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Mentz
authors.affiliation: From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.).
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Greiner
authors.affiliation: From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.).
authors.forename: Adam D
authors.initials: AD
authors.lastname: DeVore
authors.affiliation: From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.).
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Dunlay
authors.affiliation: From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.).
authors.forename: Gaurav
authors.initials: G
authors.lastname: Choudhary
authors.affiliation: From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.).
authors.forename: Tariq
authors.initials: T
authors.lastname: Ahmad
authors.affiliation: From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.).
authors.forename: Prateeti
authors.initials: P
authors.lastname: Khazanie
authors.affiliation: From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.).
authors.forename: Tiffany C
authors.initials: TC
authors.lastname: Randolph
authors.affiliation: From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.).
authors.forename: Michael E
authors.initials: ME
authors.lastname: Griswold
authors.affiliation: From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.).
authors.forename: Zubin J
authors.initials: ZJ
authors.lastname: Eapen
authors.affiliation: From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.).
authors.forename: Emily C
authors.initials: EC
authors.lastname: O'Brien
authors.affiliation: From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.).
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Thomas
authors.affiliation: From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.).
authors.forename: Lesley H
authors.initials: LH
authors.lastname: Curtis
authors.affiliation: From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.).
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006333:Heart Failure / Q000208:ethnology* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D064887:Observational Studies as Topic; D016016:Proportional Hazards Models; D012307:Risk Factors; D013318:Stroke Volume; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology* / Q000503:physiopathology
keywords: African American; heart failure; mortality; ventricular conduction