Increase in QRS amplitudes is better than N-terminal pro-B-type natriuretic peptide to predict clinical improvement...

We aimed to investigate the correlation between ECG QRS voltage changes, N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and clinical improvement in decompensated heart failure (DHF).

DHF patients (n=56) with a mean age of 67.5±12.6 years showed limb QRS amplitude increase and NT-proBNP level decrease with clinical improvement (p<0.001). Significant correlation was found between percent changes (Δ%) in body weight and Δ% in QRS voltages of aVR, aVF, DII, ΣQRSI+II and ΣQRS (all limb-leads) (r = -0.40; r = -0.35; r = -0.32; r = -0.30; r = -0.30 respectively, p<0.05). No correlation was found between Δ% in NT-proBNP and body weight (r = -0.23, p=0.09). Δ% NT-proBNP was correlated with Δ% QRS voltage only in aVR (r = -0.312, p=0.019). In ROC analysis, ≥0.5 mm increase in aVR QRS voltage was found to predict ≥5 kg weight loss with a sensitivity of 74% and specificity of 62% (p=0.013, AUC: 0.699).

Increase in QRS voltages especially in aVR was found to be more sensitive than NT-proBNP to predict clinical improvement in DHF.