Incremental changes in QRS duration as predictor for cardiovascular disease: a 21-year follow-up of a randomly selected general population

Abstract

The QRS complex has been shown to be a prognostic marker in coronary artery disease. However, the changes in QRS duration over time, and its predictive value for cardiovascular disease in the general population is poorly studied. So we aimed to explore if increased QRS duration from the age of 50–60 is associated with increased risk of major cardiovascular events during a further follow-up to age 71. A random population sample of 798 men born in 1943 were examined in 1993 at 50 years of age, and re-examined in 2003 at age 60 and 2014 at age 71. Participants who developed cardiovascular disease before the re-examination in 2003 (n = 86) or missing value of QRS duration in 2003 (n = 127) were excluded. ΔQRS was defined as increase in QRS duration from age 50 to 60. Participants were divided into three groups: group 1: ΔQRS < 4 ms, group 2: 4 ms ≤ ΔQRS < 8 ms, group 3: ΔQRS ≥ 8 ms. Endpoints were major cardiovascular events. And we found compared with men in group 1 (ΔQRS < 4 ms), men with ΔQRS ≥ 8 ms had a 56% increased risk of MACE during follow-up to 71 years of age after adjusted for BMI, systolic blood pressure, smoking, hyperlipidemia, diabetes and heart rate in a multivariable Cox regression analysis (HR 1.56, 95% CI:1.07–2.27, P = 0.022). In conclusion, in this longitudinal follow-up over a decade QRS duration increased in almost two out of three men between age 50 and 60 and the increased QRS duration in middle age is an independent predictor of major cardiovascular events.

Multi-modal characterisation of cardiac function and electrophysiology in type 2 diabetes: a UK Biobank cross-sectional study

“…In the ACCORD trial, QRS duration was increased in patients with diabetes and incident heart failure (HF) compared to those without HF [53]. Additionally, a longer QRS complex was established as an independent predictor of cardiovascular events in middle- to older-aged men and is associated with all-cause mortality in T2DM [54,55]. In contrast, in the control cohort, the Sokolow-Lyon index was the only ECG biomarker showing a significant association with the development of future CVD.…”

Possible role of QRS duration in the right ventricle as a perioperative monitoring parameter for right ventricular function: a prospective cohort analysis in robotic mitral valve surgery

“…Interestingly, the mean Δ QRS RV in patients with prolonged postoperative QRS RV duration (>100 ms) was 12 ms, whereas it was just 0.6 ms in those with QRS RV ≤ 100 ms. Previous studies investigated the relationships between individual increases in QRS duration and worse clinical outcomes in the general population as well as in patients with heart failure ( 33 – 36 ). In these reports, a QRS duration increase of only 10 ms elevated the cardiovascular risks in the study population, such as cardiac death or adverse cardiac events.…”

Deep Learning of Electrocardiograms Enables Scalable Human Disease Profiling

“…We chose an intervals-based model as our comparator because it utilizes routinely ascertained, standardized, and automated measurements known to have disease-based prognostic implications. [50][51][52][53][54] As above, we performed an intervals PheWAS in each dataset and meta-analyzed results. We then compared the number of significant associations between the latent space models and the ECG intervals model, using a Bonferroni-corrected two-sided p-value of 0.05 divided by the number of common diseases across all meta-analyses.…”