Open AccessThe Prognostic Significance of Narrow Fragmented QRS on Admission Electrocardiogram in Patients Hospitalized for Decompensated Systolic Heart Failure
Author(s) -
Ozcan Sevgi,
Cakmak Huseyin Altug,
Ikitimur Baris,
Yurtseven Ece,
Stavileci Berna,
Tufekcioglu Ebru Yucel,
Enar Rasim
Publication year - 2013
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22158
Subject(s) - medicine , cardiology , hazard ratio , heart failure , ejection fraction , odds ratio , confidence interval , hypoalbuminemia , qrs complex , proportional hazards model , acute decompensated heart failure
Background Narrow fragmented QRS ( fQRS ) has recently been recognized as a significant predictor of prognosis in various cardiovascular diseases. Hypothesis We hypothesized that the presence of narrow fQRS on admission electrocardiogram ( ECG ) in patients with decompensated systolic heart failure ( HF ) of any cause would be associated with long‐term prognosis. Methods Patients hospitalized for decompensated HF due to ischemic or nonischemic dilated cardiomyopathy (left ventricular ejection fraction <35%) were retrospectively analyzed. The primary clinical end points were cardiovascular mortality, sudden cardiac death, and rehospitalization for HF . Results The mean duration of follow‐up was 3.73 ± 1.41 years. Patients were classified as fQRS (+) group (n = 114; mean age, 63.49 ± 12.04 years) and fQRS (−) group (n = 113 patients; mean age, 65.04 ± 11.95 years). fQRS on ECG was significantly correlated with New York Heart Association ( NYHA ) functional class ( P = 0.001). In multivariate Cox proportional hazard analysis, narrow fQRS (odds ratio [ OR ]: 3.130, 95% confidence interval [ CI ]: 1.560‐2.848, P = 0.001), chronic renal failure ( OR : 2.455, 95% CI : 1.120‐5.381, P = 0.025), NYHA class ( OR : 8.305, 95% CI : 2.568‐26.855, P < 0.0001), and hypoalbuminemia ( OR : 2.099, 95% CI : 1.122‐3.926, P = 0.020) were independent predictors of cardiovascular mortality. In Kaplan‐Meier survival analysis, narrow fQRS on admission ECG predicted worse survival rate at 84 months; survival probability significantly decreased in the fQRS (+) group compared with fQRS (−) group ( P < 0.0001). Conclusions Presence of narrow fQRS is associated with worse NYHA functional class in patients hospitalized for decompensated HF . Narrow fQRS predicts cardiovascular mortality in a specific subgroup of systolic HF patients, namely those hospitalized for decompensated HF of both ischemic and nonischemic causes.