Internal and Emergency Medicine

, Volume 9, Issue 3, pp 283–291 | Cite as

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

  • Jan VáclavíkEmail author
  • Jindřich Špinar
  • David Vindiš
  • Jiří Vítovec
  • Petr Widimský
  • Čestmír Číhalík
  • Aleš Linhart
  • Filip Málek
  • Miloš TáborskýEmail author
  • Ladislav Dušek
  • Jiří Jarkovský
  • Marián Fedorco
  • Marián Felšöci
  • Roman Miklík
  • Jiří Pařenica


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.


Electrocardiography ECG Acute heart failure Prognosis Mortality 





Acute Heart Failure Database


Acute heart failure


Right bundle branch block


Left bundle branch block



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.


  1. 1.
    Dickstein K, Cohen-Solal A, Filippatos G et al (2008) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J 29:2388–2442PubMedCrossRefGoogle Scholar
  2. 2.
    Nieminen MS, Brutsaert D, Dickstein K et al (2006) EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population. Eur Heart J 27:2725–2736PubMedCrossRefGoogle Scholar
  3. 3.
    WRITING GROUP, Lloyd-Jones D, Adams RJ, Brown TM et al (2010) Executive summary: heart disease and stroke statistics—2010 update: a report from the American Heart Association. Circulation 121:948–954PubMedCrossRefGoogle Scholar
  4. 4.
    Danciu SC, Gonzalez J, Gandhi N et al (2006) Comparison of six-month outcomes and hospitalization rates in heart failure patients with and without preserved left ventricular ejection fraction and with and without intraventricular conduction defect. Am J Cardiol 97:256–259PubMedCrossRefGoogle Scholar
  5. 5.
    Breidthardt T, Christ M, Matti M et al (2007) QRS and QTc interval prolongation in the prediction of long-term mortality of patients with acute destabilised heart failure. Heart 93:1093–1097PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Wang NC, Maggioni AP, Konstam MA, Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan (EVEREST) Investigators et al (2008) Clinical implications of QRS duration in patients hospitalized with worsening heart failure and reduced left ventricular ejection fraction. JAMA 299:2656–2666PubMedCrossRefGoogle Scholar
  7. 7.
    Hummel SL, Skorcz S, Koelling TM (2009) Prolonged electrocardiogram QRS duration independently predicts long-term mortality in patients hospitalized for heart failure with preserved systolic function. J Card Fail 15:553–560PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Spargias KS, Lindsay SJ, Kawar GI et al (1999) QT dispersion as a predictor of long-term mortality in patients with acute myocardial infarction and clinical evidence of heart failure. Eur Heart J 20:1158–1165PubMedCrossRefGoogle Scholar
  9. 9.
    McCullough PA, Hassan SA, Pallekonda V et al (2005) Bundle branch block patterns, age, renal dysfunction, and heart failure mortality. Int J Cardiol 102:303–308PubMedCrossRefGoogle Scholar
  10. 10.
    Barsheshet A, Goldenberg I, Garty M et al (2011) Relation of bundle branch block to long-term (four-year) mortality in hospitalized patients with systolic heart failure. Am J Cardiol 107:540–544PubMedCrossRefGoogle Scholar
  11. 11.
    Abdel-Qadir HM, Tu JV, Austin PC et al (2011) Bundle branch block patterns and long-term outcomes in heart failure. Int J Cardiol 146:213–218PubMedCrossRefGoogle Scholar
  12. 12.
    Mueller C, Laule-Kilian K, Klima T et al (2006) Right bundle branch block and long-term mortality in patients with acute congestive heart failure. J Intern Med 260:421–428PubMedCrossRefGoogle Scholar
  13. 13.
    Tabrizi F, Englund A, Rosenqvist M et al (2007) Influence of left bundle branch block on long-term mortality in a population with heart failure. Eur Heart J 28:2449–2455PubMedCrossRefGoogle Scholar
  14. 14.
    Huvelle E, Fay R, Alla F et al (2010) Left bundle branch block and mortality in patients with acute heart failure syndrome: a substudy of the EFICA cohort. Eur J Heart Fail 12:156–163PubMedCrossRefGoogle Scholar
  15. 15.
    Shotan A, Garty M, Blondhein DS, HFSIS Steering Committee and Investigators et al (2010) Atrial fibrillation and long-term prognosis in patients hospitalized for heart failure: results from heart failure survey in Israel (HFSIS). Eur Heart J 31:309–317PubMedCrossRefGoogle Scholar
  16. 16.
    Špinar J, Aschermann M, Al Hiti L et al (2008) Acute heart failure databases in specialist departments of cardiology. Cor Vasa 50:12–21Google Scholar
  17. 17.
    Spinar J, Parenica J, Vitovec J et al (2011) Baseline characteristics and hospital mortality in the Acute Heart Failure Database (AHEAD) main registry. Crit Care 15:R291PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Spinarova L, Spinar J, Vitovec J et al (2012) Gender differences in total cholesterol levels in patients with acute heart failure and its importance for short and long time prognosis. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 156(1):21–28PubMedCrossRefGoogle Scholar
  19. 19.
    Mason JW, Hancock EW, Gettes LS et al (2007) Recommendations for the standardization and interpretation of the electrocardiogram: part II: electrocardiography diagnostic statement list. J Am Coll Cardiol 49:1128–1135PubMedCrossRefGoogle Scholar
  20. 20.
    Surawicz B, Childers R, Deal BJ et al (2009) AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part III: intraventricular conduction disturbances. J Am Coll Cardiol 53:976–981PubMedCrossRefGoogle Scholar
  21. 21.
    Rautaharju PM, Surawicz B, Gettes LS et al (2009) AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part IV: the ST segment, T and U waves, and the QT interval. J Am Coll Cardiol 53:982–991PubMedCrossRefGoogle Scholar
  22. 22.
    Wagner GS, Macfarlane P, Wellens H et al (2009) AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part VI: acute ischemia/infarction. J Am Coll Cardiol 53:1003–1011PubMedCrossRefGoogle Scholar
  23. 23.
    Siirilä-Waris K, Assus J, Elin J et al (2006) Characteristics, outcomes, and predictors of 1-year mortality in patients hospitalized for acute heart failure. Eur Heart J 27:3011–3017PubMedCrossRefGoogle Scholar
  24. 24.
    Fonarow GC, Adams KF, Abraham WT et al (2005) Risk stratification for in-hospital mortality in acutely decompensated heart failure. JAMA 293:572–580PubMedCrossRefGoogle Scholar
  25. 25.
    Vrtovec B, Delgado R, Zewail A et al (2003) Prolonged QTc interval and high B-type natriuretic peptide levels together predict mortality in patients with advanced heart failure. Circulation 107:1764–1769PubMedCrossRefGoogle Scholar
  26. 26.
    Widimsky P, Zelizko M, Jansky P et al (2007) The incidence, treatment strategies and outcomes of acute coronary syndromes in the “reperfusion network” of different hospital types in the Czech Republic: results of the Czech evaluation of acute coronary syndromes in hospitalized patients (CZECH) registry. Int J Cardiol 119:212–219PubMedCrossRefGoogle Scholar

Copyright information

© SIMI 2012

Authors and Affiliations

  • Jan Václavík
    • 1
    Email author
  • Jindřich Špinar
    • 2
  • David Vindiš
    • 1
  • Jiří Vítovec
    • 3
  • Petr Widimský
    • 4
  • Čestmír Číhalík
    • 1
    • 5
  • Aleš Linhart
    • 6
  • Filip Málek
    • 7
  • Miloš Táborský
    • 1
    Email author
  • Ladislav Dušek
    • 8
  • Jiří Jarkovský
    • 8
  • Marián Fedorco
    • 1
  • Marián Felšöci
    • 2
  • Roman Miklík
    • 2
  • Jiří Pařenica
    • 2
  1. 1.Department of Internal Medicine I-CardiologyUniversity Hospital Olomouc, Palacký University School of MedicineOlomoucCzech Republic
  2. 2.Department of Internal Cardiology MedicineUniversity Hospital BrnoBrnoCzech Republic
  3. 3.First Department of Internal Cardioangiology MedicineUniversity Hospital St. Anne’sBrnoCzech Republic
  4. 4.Cardiocenter, Third Faculty of Medicine, University Hospital Kralovské VinohradyCharles UniversityPragueCzech Republic
  5. 5.Internal Cardiology DepartmentT. Bata Regional HospitalZlinCzech Republic
  6. 6.2nd Department of Internal Cardiovascular Medicine, First Medical Faculty, General University Hospital in PragueCharles University in PraguePragueCzech Republic
  7. 7.Department of CardiologyNa Homolce HospitalPragueCzech Republic
  8. 8.Institute of Biostatistics and Analyses, Faculty of MedicineMasaryk UniversityBrnoCzech Republic

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