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

Dr. Jacob Joseph

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.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Joseph: Measuring QRS duration might be a useful way of identifying higher risk HFPEF patients for more intense multidisciplinary management to prevent adverse outcomes.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Joseph: It would be useful to study whether QRS duration could be used to identify higher risk populations with higher rates of events for enrollment in clinical trials in HFPEF.  Further research examining whether biomarkers of cardiac remodeling or fibrosis are associated with prolonged QRS duration in HFPEF might be useful in understanding the biological mechanisms behind this relationship.

MedicalResearch.com: Is there anything else you would like to add?

Dr. Joseph: It is an interesting question whether cardiac resynchronization therapy would have any benefit in patients with HFPEF and prolonged QRS duration. Further studies are needed to address this issue.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Joseph J, Claggett BC, Anand IS, et al. QRS Duration Is a Predictor of Adverse Outcomes in Heart Failure with Preserved Ejection Fraction.JCHF. 2016;():. doi:10.1016/j.jchf.2016.02.013.[wysija_form id=”5″]

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