The prognostic significance of narrow fragmented QRS on admission electrocardiogram in patients hospitalized for decompensated systolic heart failure.

BACKGROUND

Narrow fragmented QRS (fQRS) has recently been recognized as a significant predictor of prognosis in various cardiovascular diseases.

HYPOTHESIS

We hypothesized that the presence of narrow fQRS on admission electrocardiogram (ECG) in patients with decompensated systolic heart failure (HF) of any cause would be associated with long-term prognosis.

METHODS

Patients hospitalized for decompensated HF due to ischemic or nonischemic dilated cardiomyopathy (left ventricular ejection fraction <35%) were retrospectively analyzed. The primary clinical end points were cardiovascular mortality, sudden cardiac death, and rehospitalization for HF.

RESULTS

The mean duration of follow-up was 3.73 ± 1.41 years. Patients were classified as fQRS(+) group (n = 114; mean age, 63.49 ± 12.04 years) and fQRS(-) group (n = 113 patients; mean age, 65.04 ± 11.95 years). fQRS on ECG was significantly correlated with New York Heart Association (NYHA) functional class (P = 0.001). In multivariate Cox proportional hazard analysis, narrow fQRS (odds ratio [OR]: 3.130, 95% confidence interval [CI]: 1.560-2.848, P = 0.001), chronic renal failure (OR: 2.455, 95% CI: 1.120-5.381, P = 0.025), NYHA class (OR: 8.305, 95% CI: 2.568-26.855, P < 0.0001), and hypoalbuminemia (OR: 2.099, 95% CI: 1.122-3.926, P = 0.020) were independent predictors of cardiovascular mortality. In Kaplan-Meier survival analysis, narrow fQRS on admission ECG predicted worse survival rate at 84 months; survival probability significantly decreased in the fQRS(+) group compared with fQRS(-) group (P < 0.0001).

CONCLUSIONS

Presence of narrow fQRS is associated with worse NYHA functional class in patients hospitalized for decompensated HF. Narrow fQRS predicts cardiovascular mortality in a specific subgroup of systolic HF patients, namely those hospitalized for decompensated HF of both ischemic and nonischemic causes.