UnIC@RISE, Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal; Inserm, Centre d'Investigations Cliniques - Plurithématique 14-33, Université de Lorraine, and Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France.
British Heart Foundation Centre of Research Excellence, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom.
Am J Cardiol. 2023 Mar 15;191:39-42. doi: 10.1016/j.amjcard.2022.12.016. Epub 2023 Jan 10.
The QRS duration can be easily obtained from a 12-lead electrocardiogram. Increased QRS duration reflects greater ventricular activation times and often ventricular dyssynchrony. Dyssynchrony causes an impairment of the global cardiac function and adversely affects the prognosis of patients with heart failure (HF). Little is known about the impact of pharmacologic therapies on the QRS duration, particularly for patients with presymptomatic HF with a preserved left ventricular (LV) ejection fraction (i.e., stage B HF with preserved ejection fraction [HFpEF]). The HOMAGE (Heart OMics in AGEing) trial enrolled patients at risk factors for developing HF and assigned them to receive either spironolactone or the usual care for approximately 9 months in a randomized manner. This analysis reports the effect of spironolactone on the QRS duration. A total of 525 patients was included in the analysis. The median (percentile) QRS duration at baseline was 92 (84 to 106) ms. Spironolactone reduced the QRS duration at month 9 by -2.8, 95% confidence interval -4.6 to -1.0 ms, p = 0.003. No significant associations were found between month 9 changes in the QRS duration and corresponding changes in the LV ejection fraction, LV mass, LV end-diastolic volume, blood pressure, N-terminal pro-brain natriuretic peptide, and procollagen type I carboxy-terminal propeptide (all p >0.05). This analysis shows that for patients with stage B HFpEF, therapy with spironolactone for 9 months shortened the QRS duration, an effect that was not associated with reductions in LV mass or volume, supporting the hypothesis that spironolactone has direct beneficial effects to improve myocardial electrical activation in patients with stage B HFpEF.
QRS 时限可以很容易地从 12 导联心电图中获得。QRS 时限的增加反映了心室激活时间的延长，通常与心室不同步有关。不同步会导致心脏整体功能受损，并对心力衰竭（HF）患者的预后产生不利影响。关于药物治疗对 QRS 时限的影响，人们知之甚少，特别是对于有左心室（LV）射血分数保留的无症状 HF 患者（即射血分数保留的心力衰竭 B 期[HFpEF]）。HOMAGE（心脏衰老中的组学）试验招募了有发生 HF 风险的患者，并将他们随机分为接受螺内酯或常规护理，大约 9 个月。这项分析报告了螺内酯对 QRS 时限的影响。共有 525 名患者纳入分析。基线时的中位数（百分位数）QRS 时限为 92（84 至 106）ms。螺内酯在第 9 个月时使 QRS 时限缩短了 -2.8，95%置信区间为-4.6 至-1.0 ms，p=0.003。在第 9 个月时 QRS 时限的变化与 LV 射血分数、LV 质量、LV 舒张末期容积、血压、N 末端脑钠肽前体和原胶原 I 羧基末端前肽的相应变化之间没有发现显著相关性（均 p>0.05）。这项分析表明，对于 HFpEF 的 B 期患者，螺内酯治疗 9 个月可缩短 QRS 时限，这一效果与 LV 质量或容积的降低无关，支持螺内酯对 B 期 HFpEF 患者改善心肌电激活具有直接有益作用的假说。
