Cardiology Xagena

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Clinical outcomes according to QRS duration and morphology in patients with heart failure, reduced ejection fraction and mild symptoms, treated with Eplerenone

Researchers have 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 ).
Researchers have also evaluated the effect of Eplerenone in these patients according to QRS duration / morphology.

Patients were categorized as: QRS duration (ms) (i) less than 120 ( n = 1375 ); (ii) 120-149 ( n = 517 ); and (iii) greater than or equal to 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 less than 120, 120-149, and greater than or equal to 150 ms groups, respectively.

Eplerenone reduced the risk of the primary outcome and mortality, compared with placebo, consistently across the QRS duration / morphology subgroups.

In conclusion, researchers 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. ( Xagena )

Cannon JA et al, Eur J Heart Fail 2015;17:707-716