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Erschienen in: Clinical Research in Cardiology 11/2015

01.11.2015 | Original Paper

The relationship of QRS morphology with cardiac structure and function in patients with heart failure

verfasst von: Pierpaolo Pellicori, Anil C. Joseph, Jufen Zhang, Elena Lukaschuk, Nasser Sherwi, Christos V. Bourantas, Huan Loh, Andrew L. Clark, John GF Cleland

Erschienen in: Clinical Research in Cardiology | Ausgabe 11/2015

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Abstract

Introduction

The relationship of QRS morphology with cardiac structure and function in patients with heart failure is uncertain.

Methods

Patients with a clinical diagnosis of heart failure and objective evidence of cardiac dysfunction [either a left ventricular ejection fraction (LVEF) <50 % or an amino-terminal pro-brain natriuretic peptide (NT-proBNP) ≥400 pg/ml] who had been investigated by cardiac magnetic resonance imaging (CMRI) were identified. QRS duration ≥120 ms was grouped morphologically as left (LBBB), right bundle branch block (RBBB) or indeterminate.

Results

Of 877 patients, 320 (36 %) had QRS ≥ 120 ms. Compared to patients with LBBB, those with RBBB had a lower median [inter-quartile range (IQR)] right ventricular (RV) ejection fraction [RBBB: 46 (37–57); LBBB: 52 (42–61) %; p = 0.014], greater median (IQR) RV mass [RBBB: 53 (42–73); LBBB: 45 (36–56) g; p < 0.001], higher median (IQR) plasma NT-proBNP [RBBB: 2013 (659–3573); LBBB: 1159 (589–2207) pg/ml, p = 0.026], more signs of peripheral congestion and higher prevalence of atrial fibrillation but had similar LVEF. During a median follow-up of 1302 days (IQR: 742–2237), 311 patients died. Compared with patients who had QRS < 120 ms, those with RBBB [HR 1.98, 95 % CI (1.37–2.86); p < 0.001] had a higher mortality. Age and NT-proBNP were the strongest independent predictors of mortality; neither QRS nor CMRI variables improved prediction.

Conclusions

In patients with heart failure and QRS ≥ 120 ms, RBBB is associated with more severe RV dysfunction and congestion and a worse prognosis. However, neither QRS morphology nor CMRI data provide independent prognostic information in a multivariable analysis including NT-proBNP.
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Literatur
1.
Zurück zum Zitat Iuliano S, Fisher SG, Karasik PE, Fletcher RD, Singh SN, Department of Veterans Affairs Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure (2002) QRS duration and mortality in patients with congestive heart failure. Am Heart J 143:1085–1091CrossRefPubMed Iuliano S, Fisher SG, Karasik PE, Fletcher RD, Singh SN, Department of Veterans Affairs Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure (2002) QRS duration and mortality in patients with congestive heart failure. Am Heart J 143:1085–1091CrossRefPubMed
2.
Zurück zum Zitat Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt OA et al (2013) 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J 34:2281–2329CrossRefPubMed Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt OA et al (2013) 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J 34:2281–2329CrossRefPubMed
3.
Zurück zum Zitat Cleland JG, Abraham WT, Linde C, Gold MR, Young JB, Claude Daubert J et al (2013) An individual patient meta-analysis of five randomized trials assessing the effects of cardiac resynchronization therapy on morbidity and mortality in patients with symptomatic heart failure. Eur Heart J 34:3547–3556PubMedCentralCrossRefPubMed Cleland JG, Abraham WT, Linde C, Gold MR, Young JB, Claude Daubert J et al (2013) An individual patient meta-analysis of five randomized trials assessing the effects of cardiac resynchronization therapy on morbidity and mortality in patients with symptomatic heart failure. Eur Heart J 34:3547–3556PubMedCentralCrossRefPubMed
4.
Zurück zum Zitat Ruschitzka F, Abraham WT, Singh JP, Bax JJ, Borer JS, Brugada J et al (2013) Cardiac-resynchronization therapy in heart failure with a narrow QRS complex. N. Engl J Med 369:1395–1405CrossRefPubMed Ruschitzka F, Abraham WT, Singh JP, Bax JJ, Borer JS, Brugada J et al (2013) Cardiac-resynchronization therapy in heart failure with a narrow QRS complex. N. Engl J Med 369:1395–1405CrossRefPubMed
5.
Zurück zum Zitat Gervais R, Leclercq C, Shankar A, Jacobs S, Eiskjaer H, Johannessen A et al (2009) Surface electrocardiogram to predict outcome in candidates for cardiac resynchronization therapy: a sub-analysis of the CARE-HF trial. Eur J Heart Fail 11:699–705CrossRefPubMed Gervais R, Leclercq C, Shankar A, Jacobs S, Eiskjaer H, Johannessen A et al (2009) Surface electrocardiogram to predict outcome in candidates for cardiac resynchronization therapy: a sub-analysis of the CARE-HF trial. Eur J Heart Fail 11:699–705CrossRefPubMed
6.
Zurück zum Zitat Zareba W, Klein H, Cygankiewicz I, Hall WJ, McNitt S, Brown M et al (2011) Effectiveness of cardiac resynchronization therapy by QRS morphology in the multicenter automatic defibrillator implantation trial-cardiac resynchronization therapy (MADIT-CRT). Circulation 123:1061–1072CrossRefPubMed Zareba W, Klein H, Cygankiewicz I, Hall WJ, McNitt S, Brown M et al (2011) Effectiveness of cardiac resynchronization therapy by QRS morphology in the multicenter automatic defibrillator implantation trial-cardiac resynchronization therapy (MADIT-CRT). Circulation 123:1061–1072CrossRefPubMed
7.
Zurück zum Zitat McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K et al (2012) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 14:803–869CrossRefPubMed McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K et al (2012) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 14:803–869CrossRefPubMed
8.
Zurück zum Zitat Surawicz B, Childers R, Deal BJ, Gettes LS, Bailey JJ, Gorgels A et al (2009) AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part III: intraventricular conduction disturbances: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology. J Am Col Cardiol 53:976–981CrossRef Surawicz B, Childers R, Deal BJ, Gettes LS, Bailey JJ, Gorgels A et al (2009) AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part III: intraventricular conduction disturbances: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology. J Am Col Cardiol 53:976–981CrossRef
9.
Zurück zum Zitat Bourantas CV, Loh HP, Bragadeesh T, Rigby AS, Lukaschuk EI, Garg S et al (2011) Relationship between right ventricular volumes measured by cardiac magnetic resonance imaging and prognosis in patients with chronic heart failure. Eur J Heart Fail 13:52–60CrossRefPubMed Bourantas CV, Loh HP, Bragadeesh T, Rigby AS, Lukaschuk EI, Garg S et al (2011) Relationship between right ventricular volumes measured by cardiac magnetic resonance imaging and prognosis in patients with chronic heart failure. Eur J Heart Fail 13:52–60CrossRefPubMed
10.
Zurück zum Zitat Khan NK, Goode KM, Cleland JG, Rigby AS, Freemantle N, Eastaugh J et al (2007) Prevalence of ECG abnormalities in an international survey of patients with suspected or confirmed heart failure at death or discharge. Eur J Heart Fail 9:491–501CrossRefPubMed Khan NK, Goode KM, Cleland JG, Rigby AS, Freemantle N, Eastaugh J et al (2007) Prevalence of ECG abnormalities in an international survey of patients with suspected or confirmed heart failure at death or discharge. Eur J Heart Fail 9:491–501CrossRefPubMed
11.
Zurück zum Zitat Fahy GJ, Pinski SL, Miller DP, McCabe N, Pye C, Walsh MJ et al (1996) Natural history of isolated bundle branch block. Am J Cardiol 77:1185–1190CrossRefPubMed Fahy GJ, Pinski SL, Miller DP, McCabe N, Pye C, Walsh MJ et al (1996) Natural history of isolated bundle branch block. Am J Cardiol 77:1185–1190CrossRefPubMed
12.
Zurück zum Zitat Liao YL, Emidy LA, Dyer A, Hewitt JS, Shekelle RB, Paul O et al (1986) Characteristics and prognosis of incomplete right bundle branch block: an epidemiologic study. J Am Coll Cardiol 7:492–499CrossRefPubMed Liao YL, Emidy LA, Dyer A, Hewitt JS, Shekelle RB, Paul O et al (1986) Characteristics and prognosis of incomplete right bundle branch block: an epidemiologic study. J Am Coll Cardiol 7:492–499CrossRefPubMed
13.
Zurück zum Zitat Eriksson P, Hansson PO, Eriksson H, Dellborg M (1998) Bundle-branch block in a general male population: the study of men born 1913. Circulation 98:2494–2500CrossRefPubMed Eriksson P, Hansson PO, Eriksson H, Dellborg M (1998) Bundle-branch block in a general male population: the study of men born 1913. Circulation 98:2494–2500CrossRefPubMed
14.
Zurück zum Zitat Bussink BE, Holst AG, Jespersen L, Deckers JW, Jensen GB (2013) Prescott E Right bundle branch block: prevalence, risk factors, and outcome in the general population: results from the Copenhagen City Heart Study. Eur Heart J 34:138–146CrossRefPubMed Bussink BE, Holst AG, Jespersen L, Deckers JW, Jensen GB (2013) Prescott E Right bundle branch block: prevalence, risk factors, and outcome in the general population: results from the Copenhagen City Heart Study. Eur Heart J 34:138–146CrossRefPubMed
15.
Zurück zum Zitat Lund LH, Jurga J, Edner M, Benson L, Dahlström U, Linde C et al (2013) Prevalence, correlates, and prognostic significance of QRS prolongation in heart failure with reduced and preserved ejection fraction. Eur Heart J 34:529–539CrossRefPubMed Lund LH, Jurga J, Edner M, Benson L, Dahlström U, Linde C et al (2013) Prevalence, correlates, and prognostic significance of QRS prolongation in heart failure with reduced and preserved ejection fraction. Eur Heart J 34:529–539CrossRefPubMed
16.
Zurück zum Zitat Baldasseroni S, Opasich C, Gorini M, Lucci D, Marchionni N, Marini M et al (2002) Left bundle-branch block is associated with increased 1-year sudden and total mortality rate in 5517 outpatients with congestive heart failure: a report from the Italian network on congestive heart failure. Am Heart J 143:398–405CrossRefPubMed Baldasseroni S, Opasich C, Gorini M, Lucci D, Marchionni N, Marini M et al (2002) Left bundle-branch block is associated with increased 1-year sudden and total mortality rate in 5517 outpatients with congestive heart failure: a report from the Italian network on congestive heart failure. Am Heart J 143:398–405CrossRefPubMed
17.
Zurück zum Zitat Lewinter C, Torp-Pedersen C, Cleland JG, Køber L (2011) Right and left bundle branch block as predictors of long-term mortality following myocardial infarction. Eur J Heart Fail 13:1349–1354CrossRefPubMed Lewinter C, Torp-Pedersen C, Cleland JG, Køber L (2011) Right and left bundle branch block as predictors of long-term mortality following myocardial infarction. Eur J Heart Fail 13:1349–1354CrossRefPubMed
18.
Zurück zum Zitat Barsheshet A, Goldenberg I, Garty M, Gottlieb S, Sandach A, Laish-Farkash A et al (2011) Relation of bundle branch block to long-term (four-year) mortality in hospitalized patients with systolic heart failure. Am J Cardiol 107:540–544CrossRefPubMed Barsheshet A, Goldenberg I, Garty M, Gottlieb S, Sandach A, Laish-Farkash A et al (2011) Relation of bundle branch block to long-term (four-year) mortality in hospitalized patients with systolic heart failure. Am J Cardiol 107:540–544CrossRefPubMed
19.
Zurück zum Zitat Abdel-Qadir HM, Tu JV, Austin PC, Wang JT, Lee DS (2011) Bundle branch block patterns and long-term outcomes in heart failure. Int J Cardiol 146:213–218CrossRefPubMed Abdel-Qadir HM, Tu JV, Austin PC, Wang JT, Lee DS (2011) Bundle branch block patterns and long-term outcomes in heart failure. Int J Cardiol 146:213–218CrossRefPubMed
20.
Zurück zum Zitat Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Investigators et al (2004) Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N. Engl J Med 350:2140–2150CrossRefPubMed Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Investigators et al (2004) Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N. Engl J Med 350:2140–2150CrossRefPubMed
21.
Zurück zum Zitat Damy T, Ghio S, Rigby AS, Hittinger L, Jacobs S, Leyva F et al (2013) Interplay between right ventricular function and cardiac resynchronization therapy: an analysis of the CARE-HF trial (Cardiac Resynchronization-Heart Failure). J Am Coll Cardiol 61:2153–2160CrossRefPubMed Damy T, Ghio S, Rigby AS, Hittinger L, Jacobs S, Leyva F et al (2013) Interplay between right ventricular function and cardiac resynchronization therapy: an analysis of the CARE-HF trial (Cardiac Resynchronization-Heart Failure). J Am Coll Cardiol 61:2153–2160CrossRefPubMed
22.
Zurück zum Zitat Cinca J, Mendez A, Puig T, Ferrero A, Roig E, Vazquez R et al (2013) Differential clinical characteristics and prognosis of intraventricular conduction defects in patients with chronic heart failure. Eur J Heart Fail 15:877–884PubMedCentralCrossRefPubMed Cinca J, Mendez A, Puig T, Ferrero A, Roig E, Vazquez R et al (2013) Differential clinical characteristics and prognosis of intraventricular conduction defects in patients with chronic heart failure. Eur J Heart Fail 15:877–884PubMedCentralCrossRefPubMed
23.
Zurück zum Zitat Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L et al (2005) The effect of cardiac resynchronization on morbidity and mortality in heart failure. N. Engl J Med 352:1539–1549CrossRefPubMed Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L et al (2005) The effect of cardiac resynchronization on morbidity and mortality in heart failure. N. Engl J Med 352:1539–1549CrossRefPubMed
24.
Zurück zum Zitat Moss AJ, Hall WJ, Cannom DS, Klein H, Brown MW, Daubert JP et al (2009) Cardiac-resynchronization therapy for the prevention of heart-failure events. N.Engl J Med 361:1329–1338CrossRefPubMed Moss AJ, Hall WJ, Cannom DS, Klein H, Brown MW, Daubert JP et al (2009) Cardiac-resynchronization therapy for the prevention of heart-failure events. N.Engl J Med 361:1329–1338CrossRefPubMed
25.
Zurück zum Zitat Cleland JG, Keshavarzi F, Pellicori P, Dicken B (2013) Case selection for cardiac resynchronization in atrial fibrillation. Heart Fail Clin 9:461–474CrossRefPubMed Cleland JG, Keshavarzi F, Pellicori P, Dicken B (2013) Case selection for cardiac resynchronization in atrial fibrillation. Heart Fail Clin 9:461–474CrossRefPubMed
26.
Zurück zum Zitat Pellicori P, Carubelli V, Zhang J, Castiello T, Sherwi N, Clark AL et al (2013) IVC diameter in patients with chronic heart failure: relationships and prognostic significance. JACC Cardiovasc Imaging 6:16–28CrossRefPubMed Pellicori P, Carubelli V, Zhang J, Castiello T, Sherwi N, Clark AL et al (2013) IVC diameter in patients with chronic heart failure: relationships and prognostic significance. JACC Cardiovasc Imaging 6:16–28CrossRefPubMed
27.
Zurück zum Zitat Damy T, Goode KM, Kallvikbacka-Bennett A, Lewinter C, Hobkirk J, Nikitin NP et al (2010) Determinants and prognostic value of pulmonary arterial pressure in patients with chronic heart failure. Eur Heart J 31:2280–2290CrossRefPubMed Damy T, Goode KM, Kallvikbacka-Bennett A, Lewinter C, Hobkirk J, Nikitin NP et al (2010) Determinants and prognostic value of pulmonary arterial pressure in patients with chronic heart failure. Eur Heart J 31:2280–2290CrossRefPubMed
28.
Zurück zum Zitat Pellicori P, Kallvikbacka-Bennett A, Zhang J, Khaleva O, Warden J, Clark AL et al (2014) Revisiting a classical clinical sign: jugular venous ultrasound. Int J Cardiol 170:364–370CrossRefPubMed Pellicori P, Kallvikbacka-Bennett A, Zhang J, Khaleva O, Warden J, Clark AL et al (2014) Revisiting a classical clinical sign: jugular venous ultrasound. Int J Cardiol 170:364–370CrossRefPubMed
29.
Zurück zum Zitat Campbell P, Takeuchi M, Bourgoun M, Shah A, Foster E, Brown MW et al (2013) Right ventricular function, pulmonary pressure estimation, and clinical outcomes in cardiac resynchronization therapy. Circ Heart Fail 6:435–442CrossRefPubMed Campbell P, Takeuchi M, Bourgoun M, Shah A, Foster E, Brown MW et al (2013) Right ventricular function, pulmonary pressure estimation, and clinical outcomes in cardiac resynchronization therapy. Circ Heart Fail 6:435–442CrossRefPubMed
30.
Zurück zum Zitat Futter JE, Cleland JG, Clark AL (2011) Body mass indices and outcome in patients with chronic heart failure. Eur J Heart Fail 13:207–213CrossRefPubMed Futter JE, Cleland JG, Clark AL (2011) Body mass indices and outcome in patients with chronic heart failure. Eur J Heart Fail 13:207–213CrossRefPubMed
Metadaten
Titel
The relationship of QRS morphology with cardiac structure and function in patients with heart failure
verfasst von
Pierpaolo Pellicori
Anil C. Joseph
Jufen Zhang
Elena Lukaschuk
Nasser Sherwi
Christos V. Bourantas
Huan Loh
Andrew L. Clark
John GF Cleland
Publikationsdatum
01.11.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Clinical Research in Cardiology / Ausgabe 11/2015
Print ISSN: 1861-0684
Elektronische ISSN: 1861-0692
DOI
https://doi.org/10.1007/s00392-015-0861-0

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