Key result
Baseline QRS prolongation (≥100 ms) in African Americans was associated with increased all-cause mortality compared to those without prolongation (12.6% vs 7.1%; HR 1.27; 95% CI 1.03-1.56; P=0.02).
Why the study?
Does QRS prolongation increase mortality and heart failure hospitalization in African Americans?
Cohort (n=5,146)
Does QRS prolongation increase mortality and heart failure hospitalization in African Americans?
Hazard Ratio: 1.27 (95% CI 1.03–1.56)
Absolute Event Rate: 12.6% vs 7.1%
p-value: p=0.02
In African Americans, QRS prolongation (≥100 ms) is an independent predictor of increased all-cause mortality and heart failure hospitalization.
QRS prolongation may flag higher-risk African Americans for monitoring; extends ECG prognostic data but remains hypothesis-generating.
BACKGROUND: QRS prolongation is associated with adverse outcomes in mostly white populations, but its clinical significance is not well established for other groups. We investigated the association between QRS duration and mortality in African Americans. METHODS AND RESULTS: We analyzed data from 5146 African Americans in the Jackson Heart Study stratified by QRS duration on baseline 12-lead ECG. We defined QRS prolongation as QRS≥100 ms. We assessed the association between QRS duration and all-cause mortality using Cox proportional hazards models and reported the cumulative incidence of heart failure hospitalization. We identified factors associated with the development of QRS prolongation in patients with normal baseline QRS. At baseline, 30% (n=1528) of participants had QRS prolongation. The cumulative incidences of mortality and heart failure hospitalization were greater with versus without baseline QRS prolongation: 12.6% (95% confidence interval [CI], 11.0-14.4) versus 7.1% (95% CI, 6.3-8.0) and 8.2% (95% CI, 6.9-9.7) versus 4.4% (95% CI, 3.7-5.1), respectively. After risk adjustment, QRS prolongation was associated with increased mortality (hazard ratio, 1.27; 95% CI, 1.03-1.56; P=0.02). There was a linear relationship between QRS duration and mortality (hazard ratio per 10 ms increase, 1.06; 95% CI, 1.01-1.12). Older age, male sex, prior myocardial infarction, lower ejection fraction, left ventricular hypertrophy, and left ventricular dilatation were associated with the development of QRS prolongation. CONCLUSIONS: QRS prolongation in African Americans was associated with increased mortality and heart failure hospitalization. Factors associated with developing QRS prolongation included age, male sex, prior myocardial infarction, and left ventricular structural abnormalities.
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Mentz et al. (2014) conducted a cohort in QRS prolongation (n=5,146). QRS prolongation (≥100 ms) vs. Normal QRS duration (<100 ms) was evaluated on all-cause mortality (HR 1.27, 95% CI 1.03-1.56, p=0.02). Baseline QRS prolongation (≥100 ms) in African Americans was associated with increased all-cause mortality compared to those without prolongation (12.6% vs 7.1%; HR 1.27; 95% CI 1.03-1.56; P=0.02).
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