A gradually widening QRS duration trajectory was associated with a significantly higher risk of adverse cardiovascular events (HR 2.27) compared to a stable narrow trajectory in patients with HFrEF receiving guideline-directed medical therapy.
Cohort (n=520)
No
Are dynamic changes in QRS duration associated with adverse cardiovascular events in patients with HFrEF receiving guideline-directed medical therapy?
In patients with HFrEF on guideline-directed medical therapy, a gradually widening QRS duration trajectory is associated with an increased risk of adverse cardiovascular events, while a narrowing trajectory is associated with improved clinical outcomes.
Estimación del efecto: HR 2.27 (95% CI 1.72-4.46)
Tasa de eventos absoluta: 55.7% vs 16.7%
valor p: p=<0.001
Background This study aimed to investigate the association between dynamic changes in QRS duration (QRSd) and clinical outcomes in patients with heart failure with reduced ejection fraction (HFrEF) receiving guideline-directed medical therapy (GDMT). Methods We retrospectively included 520 patients with HFrEF treated at Qilu Hospital of Shandong University between January 2018 and January 2024. All patients received GDMT and regular follow-up, and those who had undergone device-based therapy were excluded. Latent growth mixture modeling was used to identify QRSd trajectories. Cox regression and Kaplan–Meier analyses were performed to assess their associations with adverse cardiovascular events. Results Seven QRSd trajectories were identified and consolidated into four classes: stable narrow (Class 1), gradually narrowing (Class 2), gradually widening (Class 3), and stable wide (Class 4). Class 3 had the highest incidence of adverse cardiovascular events (55.7%), whereas Class 2 had the lowest (4.3%) (P < 0.001). In the fully adjusted model, Class 2 was associated with a lower risk of adverse cardiovascular events (HR = 0.19, 95% CI 0.06–0.58, P = 0.003), whereas Class 3 was associated with a higher risk (HR = 2.27, 95% CI 1.72–4.46, P < 0.001). Changes in QRSd were also significantly correlated with changes in left atrial diameter, left ventricular end-diastolic diameter, left ventricular ejection fraction, and NT-proBNP (all P < 0.05). Conclusion Dynamic changes in QRSd were independently associated with clinical outcomes in patients with HFrEF receiving GDMT. QRSd widening was associated with a higher risk of adverse outcomes, whereas QRSd narrowing was associated with more favorable clinical status; both may reflect underlying structural cardiac remodeling.
Sun et al. (Mon,) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=520). Gradually widening QRS duration trajectory (Class 3) vs. Stable narrow QRS duration trajectory (Class 1) was evaluated on Adverse cardiovascular events (composite of heart failure-related rehospitalization or emergency department visits, cardiovascular mortality, receipt of any device-based therapy, and heart transplantation) (HR 2.27, 95% CI 1.72-4.46, p=<0.001). A gradually widening QRS duration trajectory was associated with a significantly higher risk of adverse cardiovascular events (HR 2.27) compared to a stable narrow trajectory in patients with HFrEF receiving guideline-directed medical therapy.