Electroanatomic Ratios and Mortality in Patients With Heart Failure: Insights from the ASIAN‐HF Registry

Author:

Chyou Janice Y.1ORCID,Tay Wan Ting2ORCID,Anand Inder S.3ORCID,Teng Tiew‐Hwa Katherine2ORCID,Yap Jonathan J. L.2,MacDonald Michael R.4ORCID,Chopra Vijay5ORCID,Loh Seet Yoong6,Shimizu Wataru7ORCID,Abidin Imran Zainal8,Richards Arthur Mark9ORCID,Butler Javed10ORCID,Lam Carolyn S. P.11ORCID,

Affiliation:

1. Division of Cardiology Icahn School of Medicine at Mount Sinai and the Mount Sinai Health System New York NY

2. National Heart Centre Singapore Singapore Singapore

3. Department of Medicine University of Minnesota Medical School and VA Medical Center Minneapolis MN

4. Mount Elizabeth Medical Centre Singapore Singapore

5. Heart Institute Medanta‐The Medicity Gurugram India

6. Department of Cardiology Tan Tock Seng Hospital Singapore Singapore

7. Department of Cardiovascular MedicineNippon Medical School Tokyo Japan

8. Cardiology UnitUniversity Malaya Medical Centre Lembah Pantai Malaysia

9. Cardiovascular Research InstituteNational University of Singapore Singapore Singapore

10. Department of Medicine University of Mississippi Medical Center Jackson MI

11. National Heart Centre SingaporeDuke‐NUS Medical School Singapore Singapore

Abstract

Background QRS duration (QRSd) is a marker of electrical remodeling in heart failure. Anthropometrics and left ventricular size may influence QRSd and, in turn, may influence the association between QRSd and heart failure outcomes. Methods and Results Using the prospective, multicenter, multinational ASIAN‐HF (Asian Sudden Cardiac Death in Heart Failure) registry, this study evaluated whether electroanatomic ratios (QRSd indexed for height or left ventricular end‐diastole volume) are associated with 1‐year mortality in individuals with heart failure with reduced ejection fraction. The study included 4899 individuals (aged 60±19 years, 78% male, mean left ventricular ejection fraction: 27.3±7.1%). In the overall cohort, QRSd was not associated with all‐cause mortality (hazard ratio [HR], 1.003; 95% CI, 0.999–1.006, P =0.142) or sudden cardiac death (HR, 1.006; 95% CI, 1.000–1.013, P =0.059). QRS/height was associated with all‐cause mortality (HR, 1.165; 95% CI, 1.046–1.296, P =0.005 with interaction by sex p interaction =0.020) and sudden cardiac death (HR, 1.270; 95% CI, 1.021–1.580, P =0.032). QRS/left ventricular end‐diastole volume was associated with all‐cause mortality (HR, 1.22; 95% CI, 1.05–1.43, P =0.011) and sudden cardiac death (HR, 1.461; 95% CI, 1.090–1.957, P =0.011) in patients with nonischemic cardiomyopathy but not in patients with ischemic cardiomyopathy (all‐cause mortality: HR, 0.94; 95% CI, 0.79–1.11, P =0.467; sudden cardiac death: HR, 0.734; 95% CI, 0.477–1.132, P =0.162). Conclusions Electroanatomic ratios of QRSd indexed for body size or left ventricular size are associated with mortality in individuals with heart failure with reduced ejection fraction. In particular, increased QRS/height may be a marker of high risk in individuals with heart failure with reduced ejection fraction, and QRS/left ventricular end‐diastole volume may further risk stratify individuals with nonischemic heart failure with reduced ejection fraction. Registration URL: https://Clinicaltrials.gov . Unique identifier: NCT01633398.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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