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Background <p>This study aimed to investigate the association between dynamic changes in QRS duration (QRSd) and clinical outcomes in patients with heart failure with reduced ejection fraction (HFrEF) receiving guideline-directed medical therapy (GDMT).</p> Methods <p>We retrospectively included 520 patients with HFrEF treated at Qilu Hospital of Shandong University between January 2018 and January 2024. All patients received GDMT and regular follow-up, and those who had undergone device-based therapy were excluded. Latent growth mixture modeling was used to identify QRSd trajectories. Cox regression and Kaplan–Meier analyses were performed to assess their associations with adverse cardiovascular events.</p> Results <p>Seven QRSd trajectories were identified and consolidated into four classes: stable narrow (Class 1), gradually narrowing (Class 2), gradually widening (Class 3), and stable wide (Class 4). Class 3 had the highest incidence of adverse cardiovascular events (55.7%), whereas Class 2 had the lowest (4.3%) (<i>P</i> &lt; 0.001). In the fully adjusted model, Class 2 was associated with a lower risk of adverse cardiovascular events (HR = 0.19, 95% CI 0.06–0.58, <i>P</i> = 0.003), whereas Class 3 was associated with a higher risk (HR = 2.27, 95% CI 1.72–4.46, <i>P</i> &lt; 0.001). Changes in QRSd were also significantly correlated with changes in left atrial diameter, left ventricular end-diastolic diameter, left ventricular ejection fraction, and NT-proBNP (all <i>P</i> &lt; 0.05).</p> Conclusion <p>Dynamic changes in QRSd were independently associated with clinical outcomes in patients with HFrEF receiving GDMT. QRSd widening was associated with a higher risk of adverse outcomes, whereas QRSd narrowing was associated with more favorable clinical status; both may reflect underlying structural cardiac remodeling.</p>

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Dynamic QRS duration trajectories and prognosis in patients with HFrEF receiving guideline-directed medical therapy: a retrospective study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月25日

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  • Ziru Sun,
  • Xinyu Zhang,
  • Yijie Luo,
  • Yarui Zhao,
  • Xuyang Duan,
  • Zongwei Lin,
  • Jie Xiao,
  • Lei Wang,
  • Huixia Lu,
  • Xiaoping Ji

摘要

Background

This study aimed to investigate the association between dynamic changes in QRS duration (QRSd) and clinical outcomes in patients with heart failure with reduced ejection fraction (HFrEF) receiving guideline-directed medical therapy (GDMT).

Methods

We retrospectively included 520 patients with HFrEF treated at Qilu Hospital of Shandong University between January 2018 and January 2024. All patients received GDMT and regular follow-up, and those who had undergone device-based therapy were excluded. Latent growth mixture modeling was used to identify QRSd trajectories. Cox regression and Kaplan–Meier analyses were performed to assess their associations with adverse cardiovascular events.

Results

Seven QRSd trajectories were identified and consolidated into four classes: stable narrow (Class 1), gradually narrowing (Class 2), gradually widening (Class 3), and stable wide (Class 4). Class 3 had the highest incidence of adverse cardiovascular events (55.7%), whereas Class 2 had the lowest (4.3%) (P < 0.001). In the fully adjusted model, Class 2 was associated with a lower risk of adverse cardiovascular events (HR = 0.19, 95% CI 0.06–0.58, P = 0.003), whereas Class 3 was associated with a higher risk (HR = 2.27, 95% CI 1.72–4.46, P < 0.001). Changes in QRSd were also significantly correlated with changes in left atrial diameter, left ventricular end-diastolic diameter, left ventricular ejection fraction, and NT-proBNP (all P < 0.05).

Conclusion

Dynamic changes in QRSd were independently associated with clinical outcomes in patients with HFrEF receiving GDMT. QRSd widening was associated with a higher risk of adverse outcomes, whereas QRSd narrowing was associated with more favorable clinical status; both may reflect underlying structural cardiac remodeling.