BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark.
Eur J Heart Fail. 2020 Dec;22(12):2370-2379. doi: 10.1002/ejhf.1972. Epub 2020 Sep 14.
The importance of intra-ventricular conduction delay (IVCD), the incidence of new IVCD and its relationship to outcomes in heart failure and reduced ejection fraction (HFrEF) are not well studied. We addressed these questions in the PARADIGM-HF and ATMOSPHERE trials.
The risk of the primary composite outcome of cardiovascular death or heart failure hospitalization and all-cause mortality were estimated by use of Cox regression according to baseline QRS duration and morphology in 11 861 patients without an intracardiac device. At baseline, 1789 (15.1%) patients had left bundle branch block (LBBB), 524 (4.4%) right bundle branch block (RBBB), 454 (3.8%) non-specific IVCD, 2588 (21.8%) 'mildly abnormal' QRS (110-129 ms) and 6506 (54.9%) QRS <110 ms. During a median follow-up of 2.5 years, the risk of the primary composite endpoint was higher among those with a wide QRS, irrespective of morphology: hazard ratios (95% confidence interval) LBBB 1.36 (1.23-1.50), RBBB 1.54 (1.31-1.79), non-specific IVCD 1.65 (1.40-1.94) and QRS 110-129 ms 1.35 (1.23-1.47), compared with QRS duration <110 ms. A total of 1234 (15.6%) patients developed new-onset QRS widening ≥130 ms (6.1 per 100 patient-years). Incident LBBB occurred in 495 (6.3%) patients (2.4 per 100 patient-years) and was associated with a higher risk of the primary composite outcome [hazard ratio 1.42 (1.12-1.82)].
In patients with HFrEF, a wide QRS was associated with worse clinical outcomes irrespective of morphology. The annual incidence of new-onset LBBB was around 2.5%, and associated with a higher risk of adverse outcomes, highlighting the importance of repeat electrocardiogram review.
ClinicalTrials.gov Identifier NCT0083658 (ATMOSPHERE) and NCT01035255 (PARADIGM-HF).
室内传导延迟（IVCD）的重要性、新发 IVCD 的发生率及其与心力衰竭和射血分数降低（HFrEF）患者预后的关系尚未得到充分研究。我们在 PARADIGM-HF 和 ATMOSPHERE 试验中研究了这些问题。
在 11861 例无心脏内装置的患者中，根据基线 QRS 持续时间和形态，使用 Cox 回归估计主要复合终点（心血管死亡或心力衰竭住院和全因死亡率）的风险。基线时，1789 例（15.1%）患者存在左束支传导阻滞（LBBB），524 例（4.4%）存在右束支传导阻滞（RBBB），454 例（3.8%）存在非特异性 IVCD，2588 例（21.8%）存在“轻度异常”QRS（110-129 ms），6506 例（54.9%）QRS<110 ms。在中位随访 2.5 年期间，无论形态如何，宽 QRS 患者的主要复合终点风险更高：危险比（95%置信区间）LBBB 1.36（1.23-1.50），RBBB 1.54（1.31-1.79），非特异性 IVCD 1.65（1.40-1.94）和 QRS 110-129 ms 1.35（1.23-1.47），与 QRS 持续时间<110 ms 相比。共有 1234 例（15.6%）患者新发 QRS 增宽≥130 ms（6.1/100 患者-年）。新发 LBBB 发生在 495 例（6.3%）患者中（2.4/100 患者-年），与主要复合终点风险较高相关[危险比 1.42（1.12-1.82）]。
在 HFrEF 患者中，宽 QRS 与临床结局不良相关，无论形态如何。新发 LBBB 的年发生率约为 2.5%，与不良结局风险增加相关，这凸显了重复心电图检查的重要性。
ClinicalTrials.gov 标识符 NCT0083658（ATMOSPHERE）和 NCT01035255（PARADIGM-HF）。
