Prognostic Value of QRS Duration among Patients with Cardiogenic Shock Complicating Acute Heart Failure: Data from the Korean Acute Heart Failure (KorAHF) Registry

Jung Ae Hong, Min-Seok Kim, Hanbit Park, Sang Eun Lee, Hae-Young Lee, Hyun-Jai Cho, Jin Oh Choi, Eun-Seok Jeon, Kyung-Kuk Hwang, Shung Chull Chae, Sang Hong Baek, Seok-Min Kang, Dong-Ju Choi, Byung-Su Yoo, Kye Hun Kim, Myeong-Chan Cho, Jae-Joong Kim, Byung-Hee Oh, Jung Ae Hong, Min-Seok Kim, Hanbit Park, Sang Eun Lee, Hae-Young Lee, Hyun-Jai Cho, Jin Oh Choi, Eun-Seok Jeon, Kyung-Kuk Hwang, Shung Chull Chae, Sang Hong Baek, Seok-Min Kang, Dong-Ju Choi, Byung-Su Yoo, Kye Hun Kim, Myeong-Chan Cho, Jae-Joong Kim, Byung-Hee Oh

Abstract

Background and objectives: Prolonged QRS duration is associated with poor outcomes in patients with chronic heart failure (HF). However, the prognostic value of QRS duration in patients with cardiogenic shock complicating acute HF remains unknown. We evaluated the hypothesis that prolonged QRS duration may be associated with short-term mortality among acute HF patients with cardiogenic shock (CS).

Methods: From March 2011 through December 2013, a total of 5,625 acute HF patients were consecutively enrolled in ten tertiary university hospitals. Among them, we analyzed patients who presented with CS. Patients were divided into three groups by QRS duration cutoff values of 130 and 150 ms. The primary endpoint was 30-day in-hospital mortality.

Results: Two hundred eleven patients presented with CS at admission and those with available electrocardiograms were included in this analysis. There were 35 patients with QRS durations of 150 ms or above, 30 patients with QRS durations between 130 ms and 150 ms, and 146 patients with QRS durations below 130 ms. The 30-day all cause in-hospital mortality rates were 43.7%, 33.1%, and 24.9%, respectively. After multivariate adjustment, severe prolonged QRS duration was a significant prognostic factor for 30-day in-hospital mortality (hazard ratio, 1.909; 95% confidence interval, 1.024-3.558; p=0.042).

Conclusions: Prolonged QRS duration was associated with a higher risk of 30-day in-hospital mortality among patients with acute HF who presented with CS.

Trial registration: ClinicalTrials.gov Identifier: NCT01389843.

Keywords: Cardiogenic shock; Heart failure.

Conflict of interest statement

Conflict of Interest: The authors have no financial conflicts of interest.

Copyright © 2020. Korean Society of Heart Failure.

Figures

Figure 1. Patient inclusion flow chart.
Figure 1. Patient inclusion flow chart.
HF = heart failure; KorAHF = Korean Acute Heart Failure.
Figure 2. VCBs in the baseline electrocardiogram.…
Figure 2. VCBs in the baseline electrocardiogram. (A) Prevalence of VCBs in the entire study sample. (B) Prevalence of VCBs according to QRS duration.
VCB = ventricular conduction block; RBBB = right bundle branch block; LBBB = left bundle branch block; IVCD = intra-ventricular conduction delay.
Figure 3. Cumulative incidence of outcomes according…
Figure 3. Cumulative incidence of outcomes according to the QRS duration. (A) The 30-day all cause in-hospital mortality according to QRS duration. (B) The 30-day all cause in-hospital mortality according to ventricular conduction blocks.
RBBB = right bundle branch block; LBBB = left bundle branch block; IVCD = intra-ventricular conduction delay; VCB = ventricular conduction block.

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Source: PubMed

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