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Clinical outcomes according to QRS duration and morphology in the Eplerenone in Mild Patients: Hospitalization and Survival Study in Heart Failure (EMPHASIS-HF)
Cannon, Jane A. Collier, Timothy J. Shen, Li Swedberg, Karl Krum, Henry van Veldhuisen, Dirk J. Vincent, John Pocock, Stuart J. Pitt, Bertram Zannad, Faiez
Cannon, Jane A.
Collier, Timothy J.
Shen, Li
Swedberg, Karl
Krum, Henry
van Veldhuisen, Dirk J.
Vincent, John
Pocock, Stuart J.
Pitt, Bertram
Zannad, Faiez
Abstract
Aims: We examined the relationship between different degrees of QRS prolongation and different QRS morphologies and clinical outcomes in patients with heart failure, reduced ejection fraction (HF-REF), and mild symptoms in the Eplerenone in Mild Patients Hospitalization and SurvIval Study in Heart Failure trial (EMPHASIS-HF). We also evaluated the effect of eplerenone in these patients according to QRS duration/morphology. Methods and results: Patients were categorized as: QRS duration (ms) (i) < 120 (n = 1375); (ii) 120–149 (n = 517); and (iii) ≥150 (n = 383), and QRS morphology (i) normal (n = 1252); (ii) left bundle branch block (BBB) (n = 608); and (iii) right BBB/intraventricular conduction defect (IVCD) (n = 415). The outcomes examined were the composite of cardiovascular death or heart failure hospitalization and all-cause mortality. Both abnormal QRS duration and QRS morphology were associated with higher risk, e.g. the rates of the composite outcome were: 10.2, 17.6, and 15.5 per 100 patient-years in the < 120, 120–149, and ≥150 ms groups, respectively. Eplerenone reduced the risk of the primary outcome and mortality, compared with placebo, consistently across the QRS duration/morphology subgroups. Conclusion: We found that even moderate prolongation of QRS duration and right BBB/IVCD were associated with a high risk of adverse outcomes in HF-REF. Eplerenone was similarly effective, irrespective of QRS duration/morphology.
Keywords
systolic heart failure, clinical trial, eplerenone
Date
2015
Type
Journal article
Journal
European Journal of Heart Failure
Book
Volume
17
Issue
7
Page Range
707-716
Article Number
ACU Department
Collections
Relation URI
DOI
Source URL
Event URL
Open Access Status
License
File Access
Controlled