Prognostic Value of QRS Duration in Patients with Dilated Cardiomyopathy According to Left Ventricular Ejection Fraction

¹ State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 10000 Beijing, China

² Key Laboratory of Clinical Research for Cardiovascular Medications, National Health Committee, 10000 Beijing, China

^*Correspondence: yuhuizhangjoy@163.com (Yuhui Zhang); fwzhangjian62@126.com (Jian Zhang)

Rev. Cardiovasc. Med. 2023, 24(12), 362; https://doi.org/10.31083/j.rcm2412362

Submitted: 16 May 2023 | Revised: 19 July 2023 | Accepted: 27 July 2023 | Published: 25 December 2023

This is an open access article under the CC BY 4.0 license.

Abstract

Background: The prognostic significance of QRS duration (QRSd) in patients with dilated cardiomyopathy (DCM) and a left ventricular ejection fraction (LVEF) between 30% and 50% is unclear, resulting in questions regarding eligibility for cardiac resynchronisation therapy. This study aimed to explore the prognostic role of QRSd in patients with DCM and a LVEF 30–50% or LVEF $<$ 30%. Methods: Patients hospitalised at Fuwai hospital with DCM who had a LVEF $\leq$ 50% were prospectively included. The primary outcomes were a composite of death, heart transplantation, and rehospitalisation for worsening heart failure. Results: Among the 633 patients included, 302 (47.7%) had a LVEF of 30–50%. The multivariable hazard ratio (HR) for QRSd $\geq$ 120 ms was 1.65 (95% confidence interval [CI] 1.29–2.11, p $<$ 0.001) for overall DCM patients, 2.8 (95% CI 1.82–4.30, p $<$ 0.001) for patients with LVEF 30–50%, and 1.41 (95% CI 1.02–1.94, p = 0.036) for patients with LVEF $<$ 30%. QRSd $\geq$ 120 ms tended to be more strongly associated with outcome in patients with LVEF 30–50% than in those with LVEF $<$ 30% despite the non-significant interaction (p = 0.067). DCM patients with QRSd $\geq$ 120 ms and LVEF 30–50% did not experience a significantly better outcome than those with LVEF $<$ 30% and QRSd $<$ 120 ms after propensity-score matching (HR 0.91, 95% CI 0.61–1.36, p = 0.645). Conclusions: QRSd independently predicts prognosis in DCM patients irrespective of LVEF and identifies a group of high-risk patients who may benefit from device implantation despite the absence of severely reduced LVEF.

Keywords

dilated cardiomyopathy

cardiac resynchronization therapy

prognosis

electrocardiography

Funding

81873472/National Nature Science Foundation of China

2020-I2M-1-002/Chinese Academy of Medical Sciences (CAMS) Innovation Fund for Medical Science

Figures

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Fig. 1.

QRS duration distribution for DCM patients with LVEF 30–50% and LVEF $<$ 30%. The median (IQR) of QRSd was 106 (94, 126) ms in patients with LVEF 30–50% and 112 (98, 132) in patients with LVEF $<$ 30%, p = 0.003. DCM, dilated cardiomyopathy; LVEF, left ventricular ejection fraction; QRSd, QRS duration.

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