Key result
A 10 ms QRS prolongation is linked to ~37% higher 20-year CVD risk, enhancing prediction models.
Why the study?
Does the addition of baseline ECG parameters (QT interval and QRS duration) to established clinical models improve long-term cardiovascular risk prediction in apparently healthy adults?
Cohort (n=1,482)
Does the addition of baseline ECG parameters (QT interval and QRS duration) to established clinical models improve long-term cardiovascular risk prediction in apparently healthy adults?
Routine ECG parameters, particularly QRS duration, significantly enhance long-term cardiovascular risk prediction when added to established clinical models.
Answers are grounded in this paper and cite their sources.
QT/QRS prolongation should not yet guide decisions; leaves open incremental value beyond standard risk factors in prospective cohorts.
BACKGROUND We aimed to evaluate the prognostic value of electrocardiographic (ECG) parameters in estimating long-term cardiovascular disease (CVD) risk and their incremental predictive value when added to the HellenicSCORE II+ model in an apparently healthy adult population. METHODS This analysis included 1482 participants (mean age 46 ± 15 years; 49% male) from the population-based prospective ATTICA study who had baseline ECG recordings, comprehensive clinical and biochemical assessment, and complete 20-year follow-up data. RESULTS During the 20-year follow-up period, 633 of the 1482 participants (43%) experienced a first fatal or non-fatal CVD event. Out of these, 86 were fatal, leading to a 20-year CVD mortality rate of 9.5% in males and 2.4% in females (p < 0.001). QT interval and QRS duration showed significant associations for both 10-year and 20-year CVD risk, with a 10 ms prolongation in QT interval to be associated with a 4.0% increase in 10-year CVD risk (HR:1.040, 95%CI:1.017-1.064) and a 5.3% increase in 20-year CVD risk (HR:1.053, 95%CI:1.038-1.068), while the same prolongation in the QRS duration was linked to a 33.6% increase in 10-year CVD risk (HR:1.336, 95%CI:1.213-1.470) and 37.2% increase in 20-year CVD risk (HR:1.372, 95%CI:1.287-1.463). The inclusion of QRS duration increased the HellenicSCORE II+ model's performance, yielding superior discrimination and reclassification measures and improving overall risk stratification. CONCLUSIONS Routine ECG parameters, particularly QRS duration, enhance long-term CVD risk prediction beyond established clinical models. Given the wide availability and low cost of ECG, these findings support further validation and integration of ECG-derived markers into preventive risk assessment strategies.
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Chrysohoou et al. (2026) conducted a cohort in Cardiovascular disease risk in apparently healthy adults (n=1,482). ECG parameters (QT interval and QRS duration) vs. HellenicSCORE II+ model alone was evaluated on First fatal or non-fatal CVD event over 20 years (HR 1.372, 95% CI 1.287-1.463). A 10 ms prolongation in QRS duration was associated with a 37.2% increase in 20-year cardiovascular disease risk, enhancing prediction beyond established models.
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