Prevalence and Prognostic Value of Ventricular Conduction Delay in Heart Failure with Preserved Ejection Fraction

Abstract

BackgroundThe pathophysiology of heart failure (HF) with preserved ejection fraction (HFpEF) is heterogeneous and incompletely understood. This study evaluated the presence of a ventricular conduction delay (VCD) phenotype in HFpEF through QRS duration and vectorcardiographic QRS area, and their relation to adverse outcomes.MethodsThis study included consecutive ambulatory HFpEF patients. Baseline QRS duration was obtained from a electrocardiogram (ECG). QRS area was derived from vectorcardiographic analyses of the ECG. QRS duration and area were assessed and analysed as categorical (<100ms, 100-119ms, ≥120ms; ≤ 43.1µVs, >43.1µVs) and continuous variables to determine the relation to the composite outcome of HF hospitalisation and all-cause mortality.Results349 HFpEF patients were included of whom, 70% had a QRS duration <100ms compared to 21% with QRS duration 100-119ms and 9% with QRS duration ≥120ms. Only 4% had a QRS area ≥69µVs, indicating delayed lateral wall activation. After a median of 3 years follow-up, 30% of the patients had an adverse outcome. Longer QRS duration but not larger QRS area was associated with more adverse outcomes on both categorical and continuous scales (HR per 5ms increase=1.06, P = 0.033). This prognostic association was mainly present in males.ConclusionHFpEF patients have a low prevalence of a VCD phenotype(9% QRS duration ≥120ms;4% a QRS area ≥69µVs). However, QRS duration >100ms was present in 30% and was an independent predictor for adverse outcomes. Future efforts are needed to understand the mechanisms underlying the association of QRS duration and adverse outcomes, and to determine its clinical implications.

Note:
Funding declaration: FWP has research contracts with Medtronic, Biotronik, Abbott, Boston Scientific, EBR Systems and Microport CRM. KV has research contracts and received educational grants and consultancy fees from Medtronic, Abbot; Boston Scientific, Microport, Biosense Wespster and Phillips. CK has received consultancy fees and has research contracts with Phillips, TomTec Imaging Systems, Pfizer and Boehringer Ingelheim. AA has received educational grants from Pfizer and Alnylam, outside the submitted work. All grants were paid to the Maastricht university institute. JW has received personal fees from Corvia Medical and Boehringer Ingelheim, outside the submitted work. Other authors have nothing to declare.

Conflict of Interests: FWP has research contracts with Medtronic, Biotronik, Abbott, Boston Scientific, EBR Systems and Microport CRM. KV has research contracts and received educational grants and consultancy fees from Medtronic, Abbot; Boston Scientific, Microport, Biosense Wespster and Phillips. CK has received consultancy fees and has research contracts with Phillips, TomTec Imaging Systems, Pfizer and Boehringer Ingelheim. AA has received educational grants from Pfizer and Alnylam, outside the submitted work. All grants were paid to the Maastricht university institute. JW has received personal fees from Corvia Medical and Boehringer Ingelheim, outside the submitted work. Other authors have nothing to declare.

Ethical Approval: Written informed consent was provided by all included patients and the Medical Ethics Review Committee of MUMC+ approved the study (NCT04976348)

Keywords: Heart failure with preserved ejection fraction, conduction delay, electrocardiography, prognosis