Randolph Tiffany C, Broderick Samuel, Shaw Linda K, Chiswell Karen, Mentz Robert J, Kutyifa Valentina, Velazquez Eric J, Gilliam Francis R, Thomas Kevin L
Duke Clinical Research Institute, Durham, NC
Department of Medicine, Duke University School of Medicine, Durham, NC.
J Am Heart Assoc. 2017 Mar 20;6(3):e004381. doi: 10.1161/JAHA.116.004381.
Prolonged QRS duration is associated with increased mortality among heart failure patients, but race or sex differences in QRS duration and associated effect on outcomes are unknown.
We investigated QRS duration and morphology among 2463 black and white patients with heart failure and left ventricular ejection fraction ≤35% who underwent coronary angiography and 12-lead electrocardiography at Duke University Hospital from 1995 through 2011. We used multivariable Cox regression models to assess the relationship between QRS duration and all-cause mortality and investigate race-QRS and sex-QRS duration interaction. Median QRS duration was 105 ms (interquartile range [IQR], 92-132) with variation by race and sex (<0.001). QRS duration was longest in white men (111 ms; IQR, 98-139) followed by white women (108 ms; IQR, 92-140), black men (100 ms; IQR, 91-120), and black women (94 ms; IQR, 86-118). Left bundle branch block was more common in women than men (24% vs 14%) and in white (21%) versus black individuals (12%). In black patients, there was a 16% increase in risk of mortality for every 10 ms increase in QRS duration up to 112 ms (hazard ratio, 1.16; 95% CI, 1.07, 1.25) that was not present among white patients (interaction, =0.06).
Black individuals with heart failure had a shorter QRS duration and more often had non-left bundle branch block morphology than white patients. Women had left bundle branch block more commonly than men. Among black patients, modest QRS prolongation was associated with increased mortality.
QRS波时限延长与心力衰竭患者死亡率增加相关，但QRS波时限的种族或性别差异以及对预后的相关影响尚不清楚。
我们调查了1995年至2011年在杜克大学医院接受冠状动脉造影和12导联心电图检查的2463例心力衰竭且左心室射血分数≤35%的黑人和白人患者的QRS波时限和形态。我们使用多变量Cox回归模型评估QRS波时限与全因死亡率之间的关系，并研究种族-QRS波和性别-QRS波时限的相互作用。QRS波时限的中位数为105毫秒（四分位间距[IQR]，92-132），存在种族和性别差异（<0.001）。QRS波时限在白人男性中最长（111毫秒；IQR，98-139），其次是白人女性（108毫秒；IQR，92-140）、黑人男性（100毫秒；IQR，91-120）和黑人女性（94毫秒；IQR，86-118）。左束支传导阻滞在女性中比男性更常见（24%对14%），在白人（21%）中比黑人个体（12%）更常见。在黑人患者中，QRS波时限每增加10毫秒，直至112毫秒，死亡风险增加16%（风险比，1.16；95%CI，1.07，1.25），而白人患者中不存在这种情况（相互作用，=0.06）。
与白人患者相比，心力衰竭的黑人患者QRS波时限较短，且更常出现非左束支传导阻滞形态。女性比男性更常出现左束支传导阻滞。在黑人患者中，适度的QRS波延长与死亡率增加相关。
