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ECG in patients with acute heart failure can predict in-hospital and long-term mortality

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Abstract

Initial risk stratification in patients with acute heart failure (AHF) is poorly validated. Previous studies tended to evaluate the prognostic significance of only one or two selected ECG parameters. The aim of this study was to evaluate the impact of multiple ECG parameters on mortality in AHF. The Acute Heart Failure Database (AHEAD) registry collected data from 4,153 patients admitted for AHF to seven hospitals with Catheter Laboratory facilities. Clinical variables, heart rate, duration of QRS, QT and QTC intervals, type of rhythm and ST-T segment changes on admission were collected in a web-based database. 12.7 % patients died during hospitalisation, the remainder were discharged and followed for a median of 16.2 months. The most important parameters were a prolonged QRS and a junctional rhythm, which independently predict both in-hospital mortality [QRS > 100 ms, odds ratio (OR) 1.329, 95 % CI 1.052–1.680; junctional rhythm, OR 3.715, 95 % CI 1.748–7.896] and long-term mortality (QRS > 120 ms, OR 1.428, 95 % CI 1.160–1.757; junctional rhythm, OR 2.629, 95 % CI 1.538–4.496). Increased hospitalisation mortality is predicted by ST segment elevation (OR 1.771, 95 % CI 1.383–2.269) and prolonged QTC interval >475 ms (OR 1.483, 95 % CI 1.016–2.164). Presence of atrial fibrillation and bundle branch block is associated with increased unadjusted long-term mortality, but mostly reflects more advanced heart disease, and their predictive significance is attenuated in the multivariate analysis. ECG in patients admitted for acute heart failure carries significant short- and long-term prognostic information, and should be carefully evaluated.

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Abbreviations

ECG:

Electrocardiography

AHEAD:

Acute Heart Failure Database

AHF:

Acute heart failure

RBBB:

Right bundle branch block

LBBB:

Left bundle branch block

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Acknowledgments

We thank the study investigators for their contribution to the study. Participating centres and investigators: Czech Republic: University Hospital Brno, Brno: Katerina Horakova; University Hospital St. Anne’s, Brno: Tereza Mikušová, Klaudia Židková; Cardiocenter, University Hospital Kralovské Vinohrady, Prague: Filip Rohac, Richard Fojt; General University Hospital in Prague, Prague: Jan Belohlavek, Na Homolce Hospital, Prague: Petr Ostadal, Andreas Kruger; T. Bata Regional Hospital Zlin: Zdenek Coufal, Petr Hrdy, Stanislava Penasova, Miroslav Bambuch. This work was supported by Grant from the Czech Ministry of Health [9880-3]

Conflict of interest

None declared.

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Authors and Affiliations

  1. Department of Internal Medicine I-Cardiology, University Hospital Olomouc, Palacký University School of Medicine, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic

    Jan Václavík, David Vindiš, Čestmír Číhalík, Miloš Táborský & Marián Fedorco

  2. Department of Internal Cardiology Medicine, University Hospital Brno, Brno, Czech Republic

    Jindřich Špinar, Marián Felšöci, Roman Miklík & Jiří Pařenica

  3. First Department of Internal Cardioangiology Medicine, University Hospital St. Anne’s, Brno, Czech Republic

    Jiří Vítovec

  4. Cardiocenter, Third Faculty of Medicine, University Hospital Kralovské Vinohrady, Charles University, Prague, Czech Republic

    Petr Widimský

  5. Internal Cardiology Department, T. Bata Regional Hospital, Zlin, Czech Republic

    Čestmír Číhalík

  6. 2nd Department of Internal Cardiovascular Medicine, First Medical Faculty, General University Hospital in Prague, Charles University in Prague, Prague, Czech Republic

    Aleš Linhart

  7. Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic

    Filip Málek

  8. Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic

    Ladislav Dušek & Jiří Jarkovský

Authors
  1. Jan Václavík
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  2. Jindřich Špinar
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  3. David Vindiš
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  12. Marián Fedorco
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  14. Roman Miklík
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  15. Jiří Pařenica
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Corresponding authors

Correspondence to Jan Václavík or Miloš Táborský.

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For AHEAD investigators.

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Václavík, J., Špinar, J., Vindiš, D. et al. ECG in patients with acute heart failure can predict in-hospital and long-term mortality. Intern Emerg Med 9, 283–291 (2014). https://doi.org/10.1007/s11739-012-0862-1

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  • DOI: https://doi.org/10.1007/s11739-012-0862-1

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