Key result
An increase in QRS duration of ≥ 8ms between ages 50 and 60 independently predicted a 56% higher risk of major adverse cardiovascular events during an 11-year follow-up (HR 1.56).
Why the study?
Changes in QRS duration over time and its predictive value for cardiovascular disease in the general population are poorly studied.
Does an increase in QRS duration over a 10-year period predict major cardiovascular events in middle-aged men?
Cohort (n=585)
No
Does an increase in QRS duration over a 10-year period predict major cardiovascular events in middle-aged men?
Hazard Ratio: 1.56 (95% CI 1.07–2.27)
Absolute Event Rate: 33.3% vs 22.6%
p-value: p=0.021
An incremental increase in QRS duration of 8 ms or more over a decade in middle-aged men is an independent predictor of subsequent major adverse cardiovascular events.
QRS widening ≥8 ms may flag higher MACE risk in middle-aged men; leaves open whether serial ECG monitoring improves outcomes.
Background: The QRS complex has been shown to be a prognostic marker in coronary artery disease. However, the changes in QRS duration over time, and its predictive value for cardiovascular disease in the general population is poorly studied. Hypothesis: Increased QRS duration from the age of 50 to 60 is associated with increased risk of major cardiovascular events during a further follow-up to age 71. Method: A random population sample of 798 men born in 1943 were examined in 1993 at 50 years of age, and re-examined in 2003 at age 60 and 2014 at age 71. Participants who developed cardiovascular disease before the re-examination in 2003 (n=86) or missing value of QRS duration in 2003 (n=127) were excluded. ΔQRS was defined as increase in QRS duration from age 50 to 60. Participants were divided into three groups: group 1: ΔQRS <4ms, group 2: 4ms ≤ ΔQRS < 8ms, group 3: ΔQRS ≥ 8ms. Endpoints were major cardiovascular events. Result: Compared with men in group 1 (ΔQRS < 4ms), men with ΔQRS ≥ 8ms had a 56% increased risk of MACE during follow-up to 71 years of age after adjusted for BMI, systolic blood pressure, smoking, hyperlipidemia, diabetes and heart rate in a multivariable Cox regression analysis (HR 1.56, 95% CI:1.07-2.27, P=0.022). Conclusion: In this longitudinal follow-up over a decade QRS duration increased in almost two out of three men between age 50 and 60. The increased QRS duration in middle age is an independent predictor of major cardiovascular events.
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Chen et al. (2021) conducted a cohort in General population (n=585). Increase in QRS duration ≥ 8ms vs. Increase in QRS duration < 4ms was evaluated on Major adverse cardiovascular events (MACE) (HR 1.56, 95% CI 1.07-2.27, p=0.021). An increase in QRS duration of ≥ 8ms between ages 50 and 60 independently predicted a 56% higher risk of major adverse cardiovascular events during an 11-year follow-up (HR 1.56).
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