Author Interviews, Brigham & Women's - Harvard, Heart Disease / 04.04.2016
QRS Duration May Identify High Risk Heart Failure with Preserved Ejection Fraction Patients
MedicalResearch.com Interview with:
Jacob Joseph, MD, FACC, FAHA
Associate Professor of Medicine, Harvard Medical School
Cardiology Consortium Lead, VA Clinical Trial Network,
Associate Physician, Brigham & Women's Hospital
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Joseph: The background for this study is the fact that heart failure with preserved ejection fraction (HFPEF) continues to be a challenge for cardiology. Clinical trials have thus far failed to give us a treatment. One of the major issues in clinical care and research is the marked heterogeneity of this condition. Is an 80 year old woman with HFPEF, chronic kidney disease, and atrial fibrillation the same as a 50 year old hypertensive with left ventricular hypertrophy and HFPEF? In fact the recently reported TOPCAT study showed that the outcomes in patients enrolled in North and South America were significantly different from patients enrolled from Russia and Georgia, an effect that may have partly affected the results of the entire trial.
In this study we examined whether a simple clinical tool like QRS duration measured on ECG could help to identify a subgroup of HFPEF patients who are at risk of adverse outcomes. When we analyzed the patients enrolled in the TOPCAT trial, we did in fact find that prolonged QRS duration is associated with worse outcomes in HFPEF. This association was independent of the region of enrollment and traditional cardiac risk factors. We also found that the association was seen in different types of conduction blocks. Furthermore the risk of adverse events started at QRS duration of approximately 100ms.
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