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 Václavík
  • Jindřich Špinar
  • David Vindiš
  • Jiří Vítovec
  • Petr Widimský
  • Čestmír Číhalík
  • Aleš Linhart
  • Filip Málek
  • Miloš Táborský
  • Ladislav Dušek
  • Jiří Jarkovský
  • Marián Fedorco
  • Marián Felšöci
  • Roman Miklík
  • Jiří Pařenica
IM - ORIGINAL

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.

Keywords

Electrocardiography ECG Acute heart failure Prognosis Mortality 

Abbreviations

ECG

Electrocardiography

AHEAD

Acute Heart Failure Database

AHF

Acute heart failure

RBBB

Right bundle branch block

LBBB

Left bundle branch block

Notes

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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Copyright information

© SIMI 2012

Authors and Affiliations

  • Jan Václavík
    • 1
  • 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
  • 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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