Impact of QRS Duration and Morphology on the Risk of Sudden Cardiac Death in Asymptomatic Patients With Aortic Stenosis

Q: What are the key findings of this study?

In asymptomatic patients with aortic stenosis, QRS duration ≥100 ms was associated with a 5-fold higher risk of sudden cardiac death compared to <85 ms (95% CI 1.8-13.7; p=0.002).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: asymptomatic aortic stenosis (n=1542). Intervention: QRS duration ≥100 ms vs. QRS duration <85 ms. Primary outcome: sudden cardiac death (5-fold higher risk, 95% CI 1.8 to 13.7, p=0.002).

Q: What does this research mean for the field?

In asymptomatic patients with aortic stenosis, a QRS duration of ≥100 ms is independently associated with a 5-fold higher risk of sudden cardiac death compared to a QRS duration of <85 ms. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Anders M. Greve; Eva Gerdts; Kurt Boman; Christa Gohlke-Baerwolf; Anne B. Rossebø; Richard B. Devereux; Lars Køber; Simon Ray; Ronnie Willenheimer; Kristian Wachtell

doi:10.1016/j.jacc.2011.12.020

March 1, 2012Journal of the American College of Cardiology

Impact of QRS Duration and Morphology on the Risk of Sudden Cardiac Death in Asymptomatic Patients With Aortic Stenosis

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Key result

QRS ≥100 ms is linked to ~5-fold higher SCD risk in asymptomatic aortic stenosis.

5-fold higher risk
95% CI 1.8 to 13.7
P=0.002
n=1,542

Why the study?

The predictive value of QRS duration and morphology, particularly regarding the risk of sudden cardiac death during watchful waiting in asymptomatic aortic stenosis, has not been well studied.

Key Points

This study aims to explore how QRS duration and morphology can predict the risk of sudden cardiac death in patients with aortic stenosis.
Data from asymptomatic aortic stenosis patients randomized to simvastatin/ezetimibe versus placebo in the SEAS study were analyzed.
QRS duration was categorized (<85 ms, 85 to 99 ms, and ≥100 ms), excluding those with bundle branch block.
The association of QRS characteristics with cardiovascular morbidity and mortality was evaluated using multivariable analyses.
Of 1,542 patients followed for an average of 4.3 years, there were 27 sudden cardiac deaths (1.8%).
Patients with QRS duration ≥100 ms faced a 5-fold higher risk of sudden cardiac death (95% CI: 1.8 to 13.7, p = 0.002) compared to those with <85 ms.
A 2.5-fold higher risk of cardiovascular death was also noted for the same group (95% CI: 1.2 to 5.1, p = 0.01).

Study Design

Type

Cohort (n=1,542)

PICO

P

Population

1,542 asymptomatic patients with aortic stenosis followed for a mean of 4.3 years.

E

Exposure / Comparator

QRS duration ≥100 ms vs QRS duration <85 ms

O

Primary Outcome

sudden cardiac death — 5-fold higher risk (1.8 to 13.7), p=0.002

Main Result

Relative Risk: 5 (95% CI 1.8–13.7)

p-value: p=0.002

Implication

QRS ≥100 ms flags higher SCD risk in asymptomatic AS; hypothesis-generating for stratification, prospective validation required before practice change.

Abstract

OBJECTIVES: The aim of the study was to examine the predictive value of QRS duration and morphology during watchful waiting in asymptomatic patients with aortic stenosis (AS). BACKGROUND: QRS duration and morphology are associated with poor prognosis in many different populations, but the predictive value, particularly of the risk of sudden cardiac death (SCD), in asymptomatic patients with AS has not been well studied. METHODS: Data were obtained in asymptomatic AS patients randomized to simvastatin/ezetimibe combination versus placebo in the SEAS (Simvastatin and Ezetimibe in Aortic Stenosis) study. The impact of QRS duration, evaluated as a categorical variable of <85 ms versus 85 to 99 ms and ≥100 ms (excluding bundle branch block [BBB]) and QRS morphology in those with BBB, on cardiovascular morbidity and mortality was assessed by adjusting for clinical and echocardiographic covariates. RESULTS: QRS data were available in 1,542 patients who were followed for a mean of 4.3 ± 0.8 years (6,631 patient-years of follow-up). There were 68 cardiovascular deaths (4.6%), including 27 SCDs (1.8%). QRS duration was <85 ms in 900 patients (58.4%), 85 to 99 ms in 396 (25.7%), ≥100 ms in those without BBB in 144 (9.3%), and 102 (6.6%) in those with BBB. In multivariable analyses, those with QRS duration ≥100 ms had, compared with those with QRS duration <85 ms, a 5-fold higher risk of SCD (95% confidence interval: 1.8 to 13.7, p = 0.002) and a 2.5-fold higher risk of cardiovascular death (95% confidence interval: 1.2 to 5.1, p = 0.01). CONCLUSIONS: QRS duration and morphology in asymptomatic patients with AS are independently associated with a poor prognosis, particularly the risk of SCD.

Discussion

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Cite This Study

Greve et al. (2012) conducted a cohort in asymptomatic aortic stenosis (n=1,542). QRS duration ≥100 ms vs. QRS duration <85 ms was evaluated on sudden cardiac death (5-fold higher risk, 95% CI 1.8 to 13.7, p=0.002). In asymptomatic patients with aortic stenosis, QRS duration ≥100 ms was associated with a 5-fold higher risk of sudden cardiac death compared to <85 ms (95% CI 1.8-13.7; p=0.002).

synapsesocial.com/papers/6a4b7310f318da06943cd5ef https://doi.org/10.1016/j.jacc.2011.12.020

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Impact of QRS Duration and Morphology on the Risk of Sudden Cardiac Death in Asymptomatic Patients With Aortic Stenosis

Key Points

Study Design

PICO

Main Result

Implication

Abstract

Discussion

Cite This Study

Impact of QRS Duration and Morphology on the Risk of Sudden Cardiac Death in Asymptomatic Patients With Aortic Stenosis

Key Points

Study Design

PICO

Main Result

Implication

Abstract

Discussion

Cite This Study

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