Kronberg Finn Ole, Behnes Michael, Reinhardt Marielen, Abel Noah, Schmitt Alexander, Lau Felix, Bertsch Thomas, Steffen Henning Johann, Weidner Kathrin, Abumayyaleh Mohammad, Kuschyk Jürgen, Akin Ibrahim, Schupp Tobias
Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany.
Clin Res Cardiol. 2025 May 12. doi: 10.1007/s00392-025-02667-8.
The study investigates the prognostic impact of the native QRS duration in patients with heart failure and mildly reduced ejection fraction (HFmrEF).
The prognostic impact of QRS duration in HFmrEF has rarely been investigated.
Consecutive patients with HFmrEF and available 12-lead electrocardiogram were retrospectively included at one institution from 2016 to 2022. Patients with QRS duration ≥ 120 ms were compared to patients with QRS duration < 120 ms, further risk stratification was performed comparing patients with left and right bundle branch block (LBBB vs. RBBB). The primary endpoint was all-cause mortality at 30 months, secondary endpoints comprised the risk of HF-related rehospitalization.
In total, 1627 patients with HFmrEF were included with a median QRS duration of 90 ms (i.e., QRS duration ≥ 120 ms: 15%). Although the risk of long-term all-cause mortality was not affected by a prolonged QRS duration (35.1% vs. 28.7%; p = 0.057; HR = 1.254; 95% CI 0.993-1.583), patients with QRS duration ≥ 120 ms had a higher risk of HF-related rehospitalization (18.2% vs. 11.9%; p = 0.008; HR = 1.574; 95% CI 1.124-2.204). A QRS duration ≥ 120 ms was associated with long-term HF-related rehospitalization even after multivariable adjustment (HR 1.420, 95% CI 1.008-2.002, p = 0.045). Finally, the risks of long-term all-cause mortality and HF-related rehospitalization did not differ among patients with LBBB and RBBB.
A prolonged native QRS duration is independently associated with a higher risk of HF-related rehospitalization in HFmrEF, but not long-term all-cause mortality.
本研究调查了QRS波群起始至终末的时限（QRS时限）对射血分数轻度降低的心力衰竭（HFmrEF）患者预后的影响。
QRS时限对HFmrEF患者预后的影响鲜有研究。
回顾性纳入2016年至2022年在一家机构就诊的连续性HFmrEF患者及可获取的12导联心电图。将QRS时限≥120毫秒的患者与QRS时限<120毫秒的患者进行比较，并对左束支传导阻滞（LBBB）和右束支传导阻滞（RBBB）患者进行进一步的风险分层。主要终点为30个月时的全因死亡率，次要终点包括因心力衰竭再次住院的风险。
共纳入1627例HFmrEF患者，QRS时限中位数为90毫秒（即QRS时限≥120毫秒的患者占15%）。尽管QRS时限延长并不影响长期全因死亡率（35.1%对28.7%；p=0.057；风险比[HR]=1.254；95%可信区间[CI]0.993 - 1.583），但QRS时限≥120毫秒的患者因心力衰竭再次住院的风险更高（18.2%对11.9%；p=0.008；HR=1.574；95%CI 1.124 - 2.204）。即使经过多变量调整，QRS时限≥120毫秒仍与长期因心力衰竭再次住院相关（HR 1.420，95%CI 1.008 - 2.002，p=0.045）。最后，LBBB和RBBB患者的长期全因死亡率及因心力衰竭再次住院的风险无差异。
在HFmrEF患者中，QRS时限延长与因心力衰竭再次住院的较高风险独立相关，但与长期全因死亡率无关。
