Ventricular conduction and long-term heart failure outcomes and mortality in African Americans: insights from the Jackson Heart Study.
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BACKGROUND: QRS prolongation is associated with adverse outcomes in mostly white populations, but its clinical significance is not well established for other groups. We investigated the association between QRS duration and mortality in African Americans. METHODS AND RESULTS: We analyzed data from 5146 African Americans in the Jackson Heart Study stratified by QRS duration on baseline 12-lead ECG. We defined QRS prolongation as QRS≥100 ms. We assessed the association between QRS duration and all-cause mortality using Cox proportional hazards models and reported the cumulative incidence of heart failure hospitalization. We identified factors associated with the development of QRS prolongation in patients with normal baseline QRS. At baseline, 30% (n=1528) of participants had QRS prolongation. The cumulative incidences of mortality and heart failure hospitalization were greater with versus without baseline QRS prolongation: 12.6% (95% confidence interval [CI], 11.0-14.4) versus 7.1% (95% CI, 6.3-8.0) and 8.2% (95% CI, 6.9-9.7) versus 4.4% (95% CI, 3.7-5.1), respectively. After risk adjustment, QRS prolongation was associated with increased mortality (hazard ratio, 1.27; 95% CI, 1.03-1.56; P=0.02). There was a linear relationship between QRS duration and mortality (hazard ratio per 10 ms increase, 1.06; 95% CI, 1.01-1.12). Older age, male sex, prior myocardial infarction, lower ejection fraction, left ventricular hypertrophy, and left ventricular dilatation were associated with the development of QRS prolongation. CONCLUSIONS: QRS prolongation in African Americans was associated with increased mortality and heart failure hospitalization. Factors associated with developing QRS prolongation included age, male sex, prior myocardial infarction, and left ventricular structural abnormalities.
Heart Conduction System
Hypertrophy, Left Ventricular
Observational Studies as Topic
Proportional Hazards Models
Ventricular Dysfunction, Left
Published Version (Please cite this version)10.1161/CIRCHEARTFAILURE.114.001729
Publication InfoMentz, Robert J; Greiner, Melissa A; DeVore, Adam D; Dunlay, Shannon M; Choudhary, Gaurav; Ahmad, Tariq; ... Hernandez, Adrian F (2015). Ventricular conduction and long-term heart failure outcomes and mortality in African Americans: insights from the Jackson Heart Study. Circ Heart Fail, 8(2). pp. 243-251. 10.1161/CIRCHEARTFAILURE.114.001729. Retrieved from https://hdl.handle.net/10161/11076.
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Professor in Population Health Sciences
Lesley H. Curtis is Professor and Chair of the Department of Population Health Sciences in the Duke School of Medicine. A health services researcher by training, Dr. Curtis is an expert in the use of Medicare claims data for health services and clinical outcomes research, and a leader in national data quality efforts. Dr. Curtis serves as co-PI of the FDA’s Sentinel Innovation Center, Co-Investigator of the Data Core for the FDA’s Sentinel Initiative to monitor the safety of
Associate Professor of Medicine
Adam D. DeVore, MD, MHS Dr. DeVore is a cardiologist and Assistant Professor of Medicine in the Department of Medicine, Division of Cardiology, at Duke University School of Medicine. His clinical interests include caring for patients and families with heart failure, including those with left ventricular assist devices and heart transplants. He is involved in and leads multiple large studies of patients with heart failure at both Duke University Medical Center and the
Adjunct Associate Professor in the Department of Medicine
As director of the Duke Heart Failure Same-Day Access Clinic, I am dedicated to improving outcomes for patients with heart failure. This clinic allows patients to see a health care provider quickly, and receive treatments for relief of symptoms. I strive to help patients with heart failure avoid the emergency department and hospital when possible, and live better at home.As director of education IT innovations in the Department of Medicine, I lead efforts in continuing medical educat
Professor of Medicine
Associate Professor of Medicine
I am a cardiologist with a clinical and research interest in heart failure, including advanced therapies such as cardiac transplantation and mechanical assist devices or “heart pumps." I serve our group as Chief of the Heart Failure Section. I became a heart failure cardiologist in order to help patients manage their chronic disease over many months and years. I consider myself strongly committed to compassionate patient care with a focus on quality of life and patient preference.<br
Associate Professor in Population Health Sciences
I am an epidemiologist and health services researcher at the Duke Clinical Research Institute. My research focuses on comparative effectiveness, patient-centered outcomes, and pragmatic health services research in cardiovascular and pulmonary disease.Areas of expertise: Epidemiology, Health Services Research, and Clinical Decision Sciences
Associate Professor of Medicine
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Neurological injury after transcatheter aortic valve implantation: are the trees falling silently or is our hearing impaired? Browndyke, Jeffrey N; Mathew, Joseph P (Circ Cardiovasc Interv, 2013-12)
Two Cases of Late Shone Syndrome With Pulmonary Hypertension: Heart-Lung Transplant or Valve Surgery? Robich, Michael P; Stewart, Robert D; Zahka, Kenneth G; Krasuski, Richard A; Hanna, Mazen; Blackstone, Eugene H; Pettersson, Gosta B (World J Pediatr Congenit Heart Surg, 2016-01)Two cases of Shone syndrome with severe mitral and aortic valve problems and pulmonary hypertension were referred for heart-lung transplantation. Severely elevated pulmonary vascular resistance (PVR) was confirmed as was ...