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Clinical outcomes according to QRS duration and morphology in the Eplerenone in Mild Patients: Hospitalization and SurvIval Study in Heart Failure (EMPHASIS‐HF)
Author(s) -
Can Jane A.,
Collier Timothy J.,
Shen Li,
Swedberg Karl,
Krum Henry,
Van Veldhuisen Dirk J.,
Vincent John,
Pocock Stuart J.,
Pitt Bertram,
Zannad Faiez,
McMurray John J.V.
Publication year - 2015
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.303
Subject(s) - medicine , qrs complex , cardiology , heart failure , eplerenone , ejection fraction , bundle branch block , placebo , spironolactone , electrocardiography , pathology , alternative medicine
Aims We examined the relationship between different degrees of QRS prolongation and different QRS morphologies and clinical outcomes in patients with heart failure, reduced ejection fraction ( HF‐REF ), and mild symptoms in the Eplerenone in Mild Patients Hospitalization and SurvIval Study in Heart Failure trial ( EMPHASIS‐HF ). We also evaluated the effect of eplerenone in these patients according to QRS duration/morphology. Methods and results Patients were categorized as: QRS duration (ms) (i) <120 ( n = 1375); (ii) 120–149 ( n = 517); and (iii) ≥150 ( n = 383), and QRS morphology (i) normal ( n = 1252); (ii) left bundle branch block ( BBB ) ( n = 608); and (iii) right BBB /intraventricular conduction defect ( IVCD ) ( n = 415). The outcomes examined were the composite of cardiovascular death or heart failure hospitalization and all‐cause mortality. Both abnormal QRS duration and QRS morphology were associated with higher risk, e.g. the rates of the composite outcome were: 10.2, 17.6, and 15.5 per 100 patient‐years in the <120, 120–149, and ≥150 ms groups, respectively. Eplerenone reduced the risk of the primary outcome and mortality, compared with placebo, consistently across the QRS duration/morphology subgroups. Conclusion We found that even moderate prolongation of QRS duration and right BBB / IVCD were associated with a high risk of adverse outcomes in HF‐REF . Eplerenone was similarly effective, irrespective of QRS duration/morphology.