Greenberg Division of Cardiology, Weill Cornell Medical College, New York, New York 10021, USA.
J Hypertens. 2009 Nov;27(11):2271-7. doi: 10.1097/HJH.0b013e328330b66b.
Prolonged QRS duration (QRS) has been associated with left ventricular dyssynchrony and dysfunction and with the development of heart failure. However, whether persistence or development of increased QRS over time is associated with an increased incidence of heart failure in hypertensive patients, independent of blood pressure lowering and regression of electrocardiographic left ventricular hypertrophy (LVH) has not been examined.
The relation of QRS over time to incident heart failure was examined in 8945 hypertensive patients without history of heart failure who were randomly assigned to losartan-based or atenolol-based treatment. During 4.7 +/- 1.1 years follow-up, heart failure hospitalization occurred in 282 patients (3.2%): in 157 with in-treatment QRS less than 110 ms (4.6 per 1000 patient-years) and in 125 with persistence or development of QRS 110 ms or more (13.4 per 1000 patient-years). In univariate Cox analyses in which QRS during the study was entered as a time-varying covariate, in-treatment persistence or development of a QRS 110 ms or more was associated with a 153% increased risk of developing heart failure [hazard ratio 2.53, 95% confidence interval (CI) 2.00-3.20]. After adjusting for treatment, baseline risk factors for heart failure, incident myocardial infarction and for baseline and in-treatment electrocardiographic LVH and blood pressure, persistence or development of a QRS 110 ms or more remained associated with a 102% increased risk of new-onset heart failure (hazard ratio 2.02, 95% CI 1.49-2.74).
Persistence or development of a prolonged QRS during antihypertensive therapy is associated with an increased likelihood of new-onset heart failure, independent of blood pressure lowering, treatment modality and regression of electrocardiographic LVH in patients with essential hypertension. These findings suggest that serial assessment of QRS over time can be used to track the risk of heart failure in hypertensive patients.
延长的 QRS 持续时间（QRS）与左心室不同步和功能障碍以及心力衰竭的发展有关。然而，随着时间的推移，QRS 是否持续或增加是否与高血压患者心力衰竭的发生率增加有关，而不考虑降压和心电图左心室肥厚（LVH）的消退，尚未得到检验。
在 8945 例无心力衰竭病史的高血压患者中，检查了 QRS 随时间的变化与心力衰竭事件的关系，这些患者被随机分配到基于氯沙坦或阿替洛尔的治疗中。在 4.7 +/- 1.1 年的随访期间，282 例患者（3.2%）发生心力衰竭住院：治疗期间 QRS 小于 110 ms 的 157 例（每 1000 例患者年 4.6 例）和 QRS 持续或发展为 110 ms 或更高的 125 例（每 1000 例患者年 13.4 例）。在单变量 Cox 分析中，将研究期间的 QRS 作为时变协变量输入，治疗中持续或发展为 110 ms 或更高的 QRS 与心力衰竭发生风险增加 153%相关[风险比 2.53，95%置信区间（CI）2.00-3.20]。在调整治疗、心力衰竭的基线危险因素、新发心肌梗死以及基线和治疗中的心电图 LVH 和血压后，持续或发展为 110 ms 或更高的 QRS 与新发心力衰竭的风险增加 102%相关（风险比 2.02，95%CI 1.49-2.74）。
在抗高血压治疗期间，持续或发展为延长的 QRS 与新发心力衰竭的可能性增加相关，而与降压、治疗方式以及原发性高血压患者心电图 LVH 的消退无关。这些发现表明，随着时间的推移对 QRS 进行连续评估可用于跟踪高血压患者心力衰竭的风险。
