Department of Internal Medicine III, Cardiology, Angiology, Intensive Care Medicine, Saarland University, Saarland University Medical Center, Homburg/Saar, Germany.
British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
Eur J Heart Fail. 2024 Sep;26(9):1952-1963. doi: 10.1002/ejhf.3350. Epub 2024 Jul 17.
The primary aim was to evaluate the effect of dapagliflozin according to QRS duration across the spectrum of left ventricular ejection fraction (LVEF), given that prolongation of QRS duration is associated with less favourable ventricular remodelling with pharmacological therapy and worse outcomes.
A pooled analysis of the DAPA-HF and DELIVER trials, excluding patients with a paced rhythm and cardiac resynchronization therapy. Overall, 4008 patients had heart failure (HF) with reduced ejection fraction (HFrEF), and 5816 had HF with mildly reduced/preserved ejection fraction (HFmrEF/HFpEF). QRS duration was <120 ms in 7039 patients (71.7%), 120-149 ms in 1725 (17.6%), and ≥150 ms in 1060 patients (10.8%). The median follow-up time was 23 months. The rate of the primary composite outcome of cardiovascular death or worsening HF was 9.2 (95% confidence interval [CI] 8.7-9.7), 14.3 (13.0-15.7), and 15.9 (14.1-17.9) per 100 patient-years in the <120, 120-149, and ≥150 ms groups, respectively. This gradient in event rates was observed both in HFrEF and HFmrEF/HFpEF. Dapagliflozin, compared with placebo, reduced the risk of the primary outcome consistently across the QRS duration subgroups (hazard ratio [95% CI] 0.75 [0.67-0.85], 0.79 [0.65-0.96], and 0.89 [0.70-1.13] in the <120, 120-149, and ≥150 ms groups, respectively; p for interaction = 0.28). The effect of dapagliflozin on the primary outcome was consistent across the QRS duration regardless of HF phenotype that is, HFrEF or HFmrEF/HFpEF.
Prolongation of QRS duration is associated with worse outcomes irrespective of HF phenotype. Dapagliflozin reduced the risk of the primary outcome, regardless of QRS duration, in DAPA-HF and DELIVER.
鉴于 QRS 持续时间的延长与药物治疗和预后较差的心室重构相关，本研究旨在评估达格列净对左心室射血分数（LVEF）谱中 QRS 持续时间的影响。
对 DAPA-HF 和 DELIVER 试验进行了合并分析，排除了起搏节律和心脏再同步治疗的患者。共有 4008 例射血分数降低的心力衰竭（HFrEF）患者和 5816 例射血分数轻度降低/保留的心力衰竭（HFmrEF/HFpEF）患者。7039 例患者的 QRS 持续时间＜120ms（71.7%），1725 例患者的 QRS 持续时间为 120-149ms（17.6%），1060 例患者的 QRS 持续时间≥150ms（10.8%）。中位随访时间为 23 个月。心血管死亡或心力衰竭恶化的主要复合终点发生率分别为每 100 患者-年 9.2（95%置信区间[CI]8.7-9.7）、14.3（13.0-15.7）和 15.9（14.1-17.9）。这种事件发生率的梯度在 HFrEF 和 HFmrEF/HFpEF 中均观察到。与安慰剂相比，达格列净在 QRS 持续时间亚组中一致降低了主要结局的风险（风险比[95%CI]0.75[0.67-0.85]、0.79[0.65-0.96]和 0.89[0.70-1.13]，在 QRS 持续时间＜120ms、120-149ms 和≥150ms 组中，分别；交互作用的 p 值=0.28）。无论心力衰竭表型（即 HFrEF 或 HFmrEF/HFpEF）如何，达格列净对主要结局的影响均一致。
无论心力衰竭表型如何，QRS 持续时间的延长与结局较差相关。在 DAPA-HF 和 DELIVER 试验中，无论 QRS 持续时间如何，达格列净均降低了主要结局的风险。
