QRS Duration on Electrocardiography and Cardiovascular Mortality (from the National Health and Nutrition Examination Survey—III) - 30/05/13

Doi : 10.1016/j.amjcard.2013.04.040

Apurva Omkar Badheka, MD ^a, Vikas Singh, MD ^a, Nileshkumar Jasmatbhai Patel, MD ^b, Abhishek Deshmukh, MD ^c, Neeraj Shah, MD ^b, Ankit Chothani, MD ^d, Kathan Mehta, MD ^e, Peeyush Grover, MD ^a, Ghanshyambhai Tulsibhai Savani, MD ^a, Sandeepkumar Gupta, MD ^a, Ankit Rathod, MD ^f, George Robert Marzouka, MD ^a, Raul David Mitrani, MD ^a, Mauro Moscucci, MD ^a, Mauricio Gabriel Cohen, MD ^a,^⁎
^a Department of Internal Medicine, Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida
^b Department of Internal Medicine, Cardiovascular Division, Staten Island University Hospital, Staten Island, New York
^c Department of Internal Medicine, Cardiovascular Division, University of Arkansas, Little Rock, Arkansas
^d Department of Internal Medicine, Cardiovascular Division, MedStar Washington Hospital Center, Washington, District of Columbia
^e Department of Internal Medicine, Cardiovascular Division, Drexel University School of Public Health, Philadelphia, Pennsylvania
^f Department of Internal Medicine, Cardiovascular Division, Department of Internal Medicine, Cardiovascular Division, Cedars-Sinai Medical Centre, Los Angeles, California

Corresponding author: Tel: (305) 243-5050; fax: (305) 243-5578.

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Abstract

The relation of bundle branch block (BBB) with adverse outcome is controversial. We hypothesized that increased QRS duration is an independent predictor of cardiovascular (CV) mortality in a cross-sectional US population. This is a retrospective cohort study on prospectively collected data to assess the relationship between QRS duration on routine ECG and CV mortality. Participants included 8,527 patients with ECG data available from the National Health and Nutrition Examination Survey data set, representing 74,062,796 individuals in the United States. Mean age was 60.5 ± 13.6 years. Most subjects were white (87%) and women (53%). During the follow-up period of 106,244.6 person-years, 1,433 CV deaths occurred. Multivariate analysis revealed that the highest quartile of QRS duration was associated with higher CV mortality than lowest quartile (hazard ratio [HR] 1.3, 95% confidence interval [CI] 1.01 to 1.7, p = 0.04) after adjustment for established risk factors. Both left BBB (HR 2.4, 95% CI 1.3 to 4.7, p = 0.009) and right BBB (HR 1.90, 95% CI 1.2 to 3.0, p = 0.008) were significantly associated with increased CV mortality. The addition of the QRS duration in 10-millisecond increments to the Framingham Risk Score model resulted in 4.4% overall net reclassification improvement (95% CI 0.02 to 0.04; p = 0.00006). In conclusion, increased QRS duration was found to be an independent predictor of CV mortality in this cross-sectional US population. A model including QRS duration in addition to traditional risk factors was associated with improved CV risk prediction.

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