Department of Medicine, Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
Eur J Heart Fail. 2012 Nov;14(11):1285-92. doi: 10.1093/eurjhf/hfs112. Epub 2012 Jul 12.
Prolonged QRS duration (QRSd) on the electrocardiogram (ECG) has been associated with cardiac structural and functional abnormalities by echocardiography and an increased risk of heart failure (HF). Data are sparse on these relationships in middle-aged and elderly individuals free of baseline cardiovascular disease with respect to cardiac magnetic resonance imaging (MRI). We sought to determine whether QRSd is associated with incident HF and measures of cardiac structure and function by cardiac MRI.
We analysed baseline ECGs in the Multi-Ethnic Study of Atherosclerosis (MESA) to determine whether QRSd >100 ms was associated with incident HF. We adjusted for demographic and clinical risk factors, as well as MRI measures of left ventricular (LV) structure and function. Among 4591 eligible participants (51% women; 39% white; mean age 61 years), 75 developed incident HF over a mean follow-up of 7.1 years. QRSd >100 ms was significantly associated with MRI measures of cardiac structure and function, as well as incident HF, even after adjustment for demographic covariates [hazard ratio (HR) 2.10, 95% confidence interval (CI) 1.29-3.42; P = 0.003] and clinical risk factors (HR 1.86, 95% CI 1.14-3.03; P = 0.01). With further adjustment for individual LV structural measures, findings were attenuated to non-significance. Separate adjustment for LV functional measures yielded only mild attenuation.
In middle-aged and older adults without cardiovascular disease, a QRSd >100 ms was significantly associated with incident HF. After adjustment for LV structural measures, the association was attenuated to non-significance, suggesting that prolonged QRSd is potentially a useful marker of LV structure that may predispose to HF risk.
心电图（ECG）上的 QRS 时限（QRSd）与超声心动图检查的心脏结构和功能异常以及心力衰竭（HF）风险增加相关。关于无基线心血管疾病的中年和老年人，有关心脏磁共振成像（MRI）的这些关系的数据很少。我们试图确定 QRSd 是否与心脏 MRI 检查的 HF 事件和心脏结构及功能的测量指标相关。
我们对动脉粥样硬化多民族研究（MESA）的基线心电图进行了分析，以确定 QRSd＞100ms 是否与 HF 事件相关。我们调整了人口统计学和临床危险因素，以及 MRI 左心室（LV）结构和功能的测量指标。在 4591 名符合条件的参与者中（51%为女性；39%为白人；平均年龄 61 岁），75 名参与者在平均 7.1 年的随访中发生了 HF 事件。即使在调整人口统计学协变量后，QRSd＞100ms 与心脏结构和功能的 MRI 测量指标以及 HF 事件的发生显著相关[风险比（HR）2.10，95%置信区间（CI）1.29-3.42；P=0.003]，并且与临床危险因素相关（HR 1.86，95%CI 1.14-3.03；P=0.01）。进一步调整单个 LV 结构测量指标后，结果不再具有统计学意义。单独调整 LV 功能测量指标后，结果仅略有减弱。
在无心血管疾病的中年和老年人中，QRSd＞100ms 与 HF 事件显著相关。在调整 LV 结构测量指标后，这种相关性减弱至无统计学意义，这表明延长的 QRSd 可能是 LV 结构的有用标志物，可能会增加 HF 风险。
