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Fragmentation of wide QRS (f-wQRS, QRS >120 ms) predicts mortality in patients with coronary artery disease and heart failure (HF). We postulated that f-wQRS predicts mortality in patients who received cardiac resynchronization therapy (CRT) for standard indications.
We studied the clinical, ECG, and echo parameters as well as mortality data of 79 veterans (age 62+11, all males, NYHA class 3.1+ 0.3 HF, mean follow-up: 24+20 months) who received CRT. f-wQRS was defined by the presence of >2 notches on the R wave or the S wave, and had to be present in >2 contiguous inferior (II, Ill, aVF), lateral (I, aVL, V6) or anterior (V1-V5) leads even in the presence of a bundle branch block (BBB). BBBs have only two peaks or notches, whereas f-wQRS have >2 notches or peaks.
43(54%) patients had f-wQRS. The age, CHF class, ICD shock rates, drug therapy did not differ between f-wQRS group vs. non-f-wQRS group. 24(30.4%) patients died, 19(35%) patients in the f-wQRS group and 5(13%) in the non-f-wQRS group (p=0.001). Kaplan Meier survival analysis revealed a significantly decreased time to death. Multivariate predictors of death were f-wQRS (p =0.004, risk ratio: 3.8 [, 95% Cl:1.45-10.37]). Age, EF, CHF class, diabetes and prior myocardial infarction did not predict mortality.
f-wQRS is an independent predictor of mortality in patients with CRT.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Heart Failure: Cardiac Resynchronization Therapy
Abstract Category: 17. Heart Failure: Therapy
Presentation Number: 1177-307
- 2013 American College of Cardiology Foundation