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Rigshospitalet - en del af Københavns Universitetshospital
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Prevalence and incidence of intra-ventricular conduction delays and outcomes in patients with heart failure and reduced ejection fraction: insights from PARADIGM-HF and ATMOSPHERE

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

DOI

  1. Bioactive adrenomedullin in plasma is associated with biventricular filling pressures in patients with advanced heart failure

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  2. Serum potassium in the PARADIGM-HF trial

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  • PARADIGM-HF and ATMOSPHERE Committees and Investigators.
Vis graf over relationer

AIMS: The importance of intra-ventricular conduction delay (IVCD), the incidence of new IVCD and its relationship to outcomes in heart failure and reduced ejection fraction (HFrEF) are not well studied. We addressed these questions in the PARADIGM-HF and ATMOSPHERE trials.

METHODS AND RESULTS: The risk of the primary composite outcome of cardiovascular death or heart failure hospitalization and all-cause mortality were estimated by use of Cox regression according to baseline QRS duration and morphology in 11 861 patients without an intracardiac device. At baseline, 1789 (15.1%) patients had left bundle branch block (LBBB), 524 (4.4%) right bundle branch block (RBBB), 454 (3.8%) non-specific IVCD, 2588 (21.8%) 'mildly abnormal' QRS (110-129 ms) and 6506 (54.9%) QRS <110 ms. During a median follow-up of 2.5 years, the risk of the primary composite endpoint was higher among those with a wide QRS, irrespective of morphology: hazard ratios (95% confidence interval) LBBB 1.36 (1.23-1.50), RBBB 1.54 (1.31-1.79), non-specific IVCD 1.65 (1.40-1.94) and QRS 110-129 ms 1.35 (1.23-1.47), compared with QRS duration <110 ms. A total of 1234 (15.6%) patients developed new-onset QRS widening ≥130 ms (6.1 per 100 patient-years). Incident LBBB occurred in 495 (6.3%) patients (2.4 per 100 patient-years) and was associated with a higher risk of the primary composite outcome [hazard ratio 1.42 (1.12-1.82)].

CONCLUSION: In patients with HFrEF, a wide QRS was associated with worse clinical outcomes irrespective of morphology. The annual incidence of new-onset LBBB was around 2.5%, and associated with a higher risk of adverse outcomes, highlighting the importance of repeat electrocardiogram review.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT0083658 (ATMOSPHERE) and NCT01035255 (PARADIGM-HF).

OriginalsprogEngelsk
TidsskriftEuropean Journal of Heart Failure
Vol/bind22
Udgave nummer12
Sider (fra-til)2370-2379
Antal sider10
ISSN1388-9842
DOI
StatusUdgivet - dec. 2020

Bibliografisk note

© 2020 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

ID: 62248085