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Prognostic implications of QRS dispersion for major adverse cardiovascular events in asymptomatic women and men: the Multi-Ethnic Study of Atherosclerosis

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

QRS dispersion measured as the difference between maximal and minimal QRS duration in the standard 12-lead electrocardiogram has been shown to be associated with increased mortality in heart failure (HF) patients and increased arrhythmic events in patients with cardiomyopathy.

Aims

This study sought to examine the prognostic association between baseline QRS dispersion and future cardiovascular events in individuals without known prior cardiovascular disease.

Methods

The association of QRS dispersion with cardiovascular events was examined in 6510 MESA (Multi-Ethnic Study of Atherosclerosis) participants. Participants with bundle branch block were excluded. Study participants were divided into two groups based on the 95th percentile of QRS dispersion (QRS dispersion < 34 ms [group I] and QRS dispersion ≥ 34 ms [group II]). Cox proportional hazard models adjusting for demographic and clinical risk factors were used to examine the association of QRS dispersion with incident cardiovascular events (major adverse cardiovascular events [MACE]) and mortality. Analysis was repeated by forcing Framingham risk factors.

Results

Mean age was 62 ± 10 years in group I and 63 ± 10 years in group II (P = 0.02). QRS dispersion ≥ 34 ms was associated significantly with MACE (HR 1.30; 95% CI 1.04–1.62) and mortality (HR 1.33; 95% CI 1.03–1.73) after adjustment for cardiovascular risk factors and potential cofounders. Similar results were seen for mortality after adjustment for Framingham risk factors.

Conclusion

QRS dispersion ≥ 34 ms predicts cardiovascular events and mortality.

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Acknowledgments

The authors thank the other investigators, the staff, and the participants of the MESA study for their valuable contributions. A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org. We acknowledge Mamta Barmeda OT, CHT (Indiana University Health) for help in editing the manuscript.

Funding

This research was supported by contracts N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, and N01-HC-95166, from the National Heart, Lung, and Blood Institute, and by grants UL1-TR-000040 and UL1-TR-001079 from NCRR.

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Authors and Affiliations

  1. Department of Cardiology, Krannert Institute of Cardiology, Indiana University School of Medicine, 1800 N. Capitol Avenue, Indianapolis, IN, 46202, USA

    Rahul Jain

  2. Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Rahul Jain, Colin Wu, Aditya Jain, Ola Giesdal, Harjit Chahal, Saman Nazarian & João A. C. Lima

  3. Division of Cardiovascular Medicine, University of Missouri, Columbia, MO, USA

    Sandeep Gautam

  4. Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD, USA

    Colin Wu

  5. Department of Biostatistics, School of Medicine and Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA

    Changyu Shen & Hongbo Lin

  6. Radiology and Imaging Sciences, National Institute of Health, Bethesda, MD, USA

    David A. Bluemke

  7. Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention and Department of Internal Medicine, Cardiology Section, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Elsayed Z. Soliman

Authors
  1. Rahul Jain
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  2. Sandeep Gautam
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  3. Colin Wu
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  4. Changyu Shen
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  8. Hongbo Lin
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  9. David A. Bluemke
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  11. Saman Nazarian
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  12. João A. C. Lima
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Corresponding author

Correspondence to Rahul Jain.

Ethics declarations

The institutional review board at each participating site approved the MESA study protocol, and written informed consent was obtained from each participant. The study was approved by the institutional review boards of participating centers, and participants gave informed consent.

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The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the National Institutes of Health; or the U.S. Department of Health and Human Services.

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Jain, R., Gautam, S., Wu, C. et al. Prognostic implications of QRS dispersion for major adverse cardiovascular events in asymptomatic women and men: the Multi-Ethnic Study of Atherosclerosis. J Interv Card Electrophysiol 56, 45–53 (2019). https://doi.org/10.1007/s10840-019-00614-y

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  • DOI: https://doi.org/10.1007/s10840-019-00614-y

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