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      Predictive Value of QRS Fraction for Cardiovascular Death in Patients with Heart Failure: A Prospective Cohort Study in Acute Decompensated Heart Failure (Heb-ADHF)

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          Abstract

          Background:

          The QRS fraction is the ratio of the total amplitude of R waves to the total amplitude of QRS complexes ( R/QRS) on a 12-lead electrocardiogram. Our group has previously proposed calculation of the QRS fraction as a simple method for estimation of left ventricular ejection fraction. In this study, we explored the ability of the QRS fraction to predict cardiovascular death in patients with heart failure.

          Methods:

          The study had a prospective, observational design and collected epidemiological and follow-up data for 1715 patients with heart failure who were inpatients in the Department of Cardiology at the Second Hospital of Hebei Medical University between January 2017 and December 2018. The patients were stratified according to quartile of QRS fraction, namely, lower ( < 43.8%, Q1 group) middle (43.8%–61.0%, Q2 group), and higher ( > 61.0%, Q3 group).

          Results:

          One thousand and fifty-one (61.28%) of the 1715 patients were male and the median follow-up duration was 261 days (interquartile range 39, 502). There were 341 (19.88%) deaths, including 282 (16.44%) with a cardiovascular cause. The Q1, Q2, and Q3 groups comprised 431 (25.13%), 850 (49.56%), and 434 (25.31%) patients, respectively. There were significant differences in cardiovascular mortality among the three QRS fraction subgroups ( p < 0.05). Kaplan-Meier survival curves of different QRS fraction levels showed significant diffference among patients with heart failure, especially among those with preserved ejection fraction ( p = 0.025 and 0.031, log-rank test). Cox regression analysis showed that the QRS fraction was independently associated with the risk of cardiovascular death. The risk of cardiovascular death was lower in the Q2 and Q3 groups than in the Q1 group, with respective hazard ratios of 0.668 (95% confidence interval 0.457–0.974) and 0.538 (95% confidence interval 0.341–0.849).

          Conclusions:

          The QRS fraction may serve as a prognostic indicator of the long-term risk of cardiovascular death in patients with heart failure, especially those with preserved ejection fraction.

          Clinical Trial Registry:

          ChiCTR-POC-17014020.

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          Most cited references45

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          2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure

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            2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.

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              Epidemiology and risk profile of heart failure.

              Heart failure (HF) is a major public health issue, with a prevalence of over 5.8 million in the USA, and over 23 million worldwide, and rising. The lifetime risk of developing HF is one in five. Although promising evidence shows that the age-adjusted incidence of HF may have plateaued, HF still carries substantial morbidity and mortality, with 5-year mortality that rival those of many cancers. HF represents a considerable burden to the health-care system, responsible for costs of more than $39 billion annually in the USA alone, and high rates of hospitalizations, readmissions, and outpatient visits. HF is not a single entity, but a clinical syndrome that may have different characteristics depending on age, sex, race or ethnicity, left ventricular ejection fraction (LVEF) status, and HF etiology. Furthermore, pathophysiological differences are observed among patients diagnosed with HF and reduced LVEF compared with HF and preserved LVEF, which are beginning to be better appreciated in epidemiological studies. A number of risk factors, such as ischemic heart disease, hypertension, smoking, obesity, and diabetes, among others, have been identified that both predict the incidence of HF as well as its severity. In this Review, we discuss key features of the epidemiology and risk profile of HF.
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                Author and article information

                Contributors
                Role: Academic Editor
                Role: Academic Editor
                Journal
                Rev Cardiovasc Med
                RCM
                Reviews in Cardiovascular Medicine
                IMR Press
                2153-8174
                1530-6550
                27 June 2022
                July 2022
                : 23
                : 7
                : 241
                Affiliations
                [1] 1Department of Cardiology, The Second Hospital of Hebei Medical University, 050004 Shijiazhuang, Hebei, China
                Author notes
                *Correspondence: cuiweihb2h@ 123456163.com (Wei Cui)

                These authors contributed equally.

                Article
                S1530-6550(22)00610-X
                10.31083/j.rcm2307241
                11266833
                39076912
                8198d32d-1e98-4ffc-aa7c-35072e12776a
                Copyright: © 2022 The Author(s). Published by IMR Press.

                This is an open access article under the CC BY 4.0 license.

                History
                : 8 March 2022
                : 15 April 2022
                : 6 May 2022
                Categories
                Original Research

                heart failure,qrs fraction,hfpef,cardiovascular death,prognosis

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