Key result
Atrial fibrillation (12%-46% prevalence) is more common in heart failure with normal ejection fraction than reduced ejection fraction, and QRS ≥120 ms is associated with worse outcomes.
Why the study?
Little was known about ECG abnormalities in patients with heart failure and normal ejection fraction (HeFNEF) and how they relate to different etiologies or outcomes.
What is the prevalence of ECG abnormalities in patients with HeFNEF, and how do they relate to outcomes and compare to HeFREF?
Meta-Analysis (n=32,006)
What is the prevalence of ECG abnormalities in patients with HeFNEF, and how do they relate to outcomes and compare to HeFREF?
ECG abnormalities are highly variable in HeFNEF, with atrial fibrillation being more common than in HeFREF, and QRS ≥120 ms is associated with worse outcomes.
BACKGROUND: Little is known about ECG abnormalities in patients with heart failure and normal ejection fraction (HeFNEF) and how they relate to different etiologies or outcomes. METHODS AND RESULTS: We searched the literature for peer-reviewed studies describing ECG abnormalities in HeFNEF other than heart rhythm alone. Thirty five studies were identified and 32,006 participants. ECG abnormalities reported in patients with HeFNEF include atrial fibrillation (prevalence 12%-46%), long PR interval (11%-20%), left ventricular hypertrophy (LVH, 10%-30%), pathological Q waves (11%-18%), RBBB (6%-16%), LBBB (0%-8%), and long JTc (3%-4%). Atrial fibrillation is more common in patients with HeFNEF compared to those with heart failure and reduced ejection fraction (HeFREF). In contrast, long PR interval, LVH, Q waves, LBBB, and long JTc are more common in patients with HeFREF. A pooled effect estimate analysis showed that QRS duration ≥120 ms, although uncommon (13%-19%), is associated with worse outcomes in patients with HeFNEF. CONCLUSIONS: There is high variability in the prevalence of ECG abnormalities in patients with HeFNEF. Atrial fibrillation is more common in patients with HeFNEF compared to those with HeFREF. QRS duration ≥120 ms is associated with worse outcomes in patients with HeFNEF. Further studies are needed to address whether ECG abnormalities correlate with different phenotypes in HeFNEF.
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Nikolaidou et al. (2019) conducted a meta-analysis in Heart failure and normal ejection fraction (HeFNEF) (n=32,006). ECG abnormalities vs. Heart failure and reduced ejection fraction (HeFREF) was evaluated on Prevalence of ECG abnormalities and association with outcomes. Atrial fibrillation (12%-46% prevalence) is more common in heart failure with normal ejection fraction than reduced ejection fraction, and QRS ≥120 ms is associated with worse outcomes.
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