Relationship between baseline electrocardiographic measurements and outcomes in patients with high-risk heart failure: Insights from the VerICiguaT Global Study in Subjects with Heart Failure with Reduced Ejection Fraction (VICTORIA) trial

IF 16.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

European Journal of Heart Failure Pub Date : 2023-09-01 DOI:10.1002/ejhf.3021

Haran Yogasundaram, Yinggan Zheng, Eric Ly, Justin Ezekowitz, Piotr Ponikowski, Carolyn S.P. Lam, Christopher O'Connor, Robert O. Blaustein, Lothar Roessig, Tracy Temple, Cynthia M. Westerhout, Paul W. Armstrong, Roopinder K. Sandhu, for the VICTORIA Study Group

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引用次数: 1

Abstract

Aims

Whether electrocardiographic (ECG) measurements predict mortality in chronic heart failure with reduced ejection fraction (HFrEF) is unknown.

Methods and results

We studied 4880 patients from the Vericiguat Global Study in Subjects with Heart Failure with Reduced Ejection Fraction (VICTORIA) trial with a baseline 12-lead ECG. Associations between ECG measurements and mortality were estimated as hazard ratios (HR) and adjusted for the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score, N-terminal pro-B-type natriuretic peptide, and index event. Select interactions between ECG measurements, patient characteristics and mortality were examined. Over a median of 10.8 months, there were 824 cardiovascular (CV) deaths (214 sudden) and 1005 all-cause deaths. Median age was 68 years (interquartile range [IQR] 60–76), 24% were women, median ejection fraction was 30% (IQR 23–35), 41% had New York Heart Association class III/IV, and median MAGGIC score was 24 (IQR 19–28). After multivariable adjustment, significant associations existed between heart rate (per 5 bpm: HR 1.02), QRS duration (per 10 ms: HR 1.02), absence of left ventricular hypertrophy (HR 0.64) and CV death, and similarly so with all-cause death (HR 1.02; HR 1.02; HR 0.61, respectively). Contiguous pathologic Q waves were significantly associated with sudden death (HR 1.46), and right ventricular hypertrophy with all-cause death (HR 1.44). The only sex-based interaction observed was for pathologic Q waves on CV (men: HR 1.05; women: HR 1.64, p_interaction = 0.024) and all-cause death (men: HR 0.99; women: HR 1.57; p_interaction = 0.010). Whereas sudden death doubled in females, it did not differ among males (male: HR 1.25, 95% confidence interval [CI] 0.87–1.79; female: HR 2.50, 95% CI 1.23–5.06; p_interaction = 0.141).

Conclusion

Routine ECG measurements provide additional prognostication of mortality in high-risk HFrEF patients, particularly in women with contiguous pathologic Q waves.

Abstract Image

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高危心力衰竭患者的基线心电图测量与结果之间的关系：来自VerICiguaT对射血分数降低的心力衰竭受试者的全球研究（VICTORIA）试验的见解。

目的：心电图（ECG）测量是否能预测射血分数降低的慢性心力衰竭（HFrEF）的死亡率尚不清楚。方法和结果：我们对来自Vericiguat全球研究的4880名射血分数降低心力衰竭（VICTORIA）患者进行了基线12导联心电图研究。心电图测量值与死亡率之间的相关性被估计为危险比（HR），并根据Meta Analysis Global Group in Chronic Heart Failure（MAGGIC）风险评分、N-末端B型钠尿肽原和指数事件进行调整。检查心电图测量、患者特征和死亡率之间的选择性相互作用。中位数超过10.8 心血管（CV）死亡824例（突发214例），全因死亡1005例。中位年龄为68岁年（四分位间距[IQR]60-76），24%为女性，中位射血分数为30%（IQR23-35），41%为纽约心脏协会III/IV级，中位MAGGIC评分为24（IQR29-28）。多变量调整后，心率（每5 bpm:HR 1.02）、QRS持续时间（每10 ms：HR 1.02）、无左心室肥大（HR 0.64）和CV死亡，全因死亡也是如此（分别为HR 1.02、HR 1.02和HR 0.61）。连续的病理性Q波与猝死（HR 1.46）和右心室肥大与全因死亡（HR 1.44）显著相关。观察到的唯一基于性别的相互作用是CV上的病理性Q波（男性：HR 1.05；女性：HR 1.64，P = 0.024）和全因死亡（男性：HR 0.99；女性：HR 1.57；自杀 = 0.010）。尽管女性的猝死增加了一倍，但男性之间没有差异（男性：HR 1.25，95%置信区间[CI]0.87-1.79；女性：HR 2.50，95%可信区间1.23-5.06 = 0.141）。结论：常规心电图测量为高危HFrEF患者，特别是具有连续病理Q波的女性，提供了额外的死亡率预测。

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来源期刊

European Journal of Heart Failure 医学-心血管系统

CiteScore

27.30

自引率

11.50%

发文量

365

审稿时长

1 months

期刊介绍： European Journal of Heart Failure is an international journal dedicated to advancing knowledge in the field of heart failure management. The journal publishes reviews and editorials aimed at improving understanding, prevention, investigation, and treatment of heart failure. It covers various disciplines such as molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, clinical sciences, social sciences, and population sciences. The journal welcomes submissions of manuscripts on basic, clinical, and population sciences, as well as original contributions on nursing, care of the elderly, primary care, health economics, and other related specialist fields. It is published monthly and has a readership that includes cardiologists, emergency room physicians, intensivists, internists, general physicians, cardiac nurses, diabetologists, epidemiologists, basic scientists focusing on cardiovascular research, and those working in rehabilitation. The journal is abstracted and indexed in various databases such as Academic Search, Embase, MEDLINE/PubMed, and Science Citation Index.