QRS duration predicts Prognosis in Heart Failure with Mildly Reduced Ejection Fraction

F. Kronberg (Mannheim)¹, M. Behnes (Mannheim)¹, T. Schupp (Mannheim)¹, M. Abumayyaleh (Mannheim)¹, K. J. Weidner (Mannheim)¹, J. Kuschyk (Mannheim)¹, T. Bertsch (Nürnberg)², I. Akin (Mannheim)¹, M. Akin (Bochum)^3
1Universitätsklinikum Mannheim GmbH I. Medizinische Klinik Mannheim, Deutschland; ²Klinikum Nürnberg Nord Institut für klinische Chemie und Laboratoriumsmedizin und Transfusionsmedizin Nürnberg, Deutschland; ³Kath. Klinikum Bochum Kardiologie und Rhytmologie Bochum, Deutschland

Objective: The study investigates the prognostic impact of wide QRS complex in patients with heart failure with mildly reduced ejection fraction (HFmrEF).

Background: A wide native QRS complex is a recognized risk factor for adverse prognosis in patients with reduced ejection fraction, however, the prognostic impact of QRS width in HFmrEF is unknown.

Methods: Consecutive patients with HFmrEF were retrospectively included at one institution from 2016 to 2022. Patients with QRS complex ≥ 120 ms (wide) were compared to patients with QRS complex below 120 ms (narrow), further risk stratification was performed comparing patients with left and right bundle branch block (LBBB vs. RBBB). The primary endpoint was all-cause mortality at 30 months (median follow-up, long-term), secondary endpoints comprised HF-related rehospitalization.

Results: 1.698 patients were included. HFmrEF patients with wide QRS complex had higher rates of long-term all-cause mortality (29.2% vs. 36.2%; p = 0.030; HR = 1.277; 95% CI 1.024 – 1.592) and long-term HF related rehospitalisation (12.3% vs. 18.5%; p = 0.007; HR = 1.553; 95% CI 1.127 – 2.139) compared to HFmrEF with narrow QRS complex. Both LBBB and RBBB had no impact on prognosis. Furthermore, QRS duration itself was independently associated only with long-term HF-related rehospitalisation (HR 1.428, 95% CI 1.015 – 2.010, p = 0.041) after multivariable adjustment.

Conclusion: A wide QRS complex deteriorates long-term prognosis in HFmrEF.