Abnormal electrocardiogram and poor prognosis in heart failure with preserved ejection fraction
Tiantian He1, Chen Liu2, Weihao Liang2
1Department of Obstetrics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510620, PR China.
Insights
Abnormal electrocardiograms (ECG) in heart failure with preserved ejection fraction (HFpEF) predict worse outcomes, including cardiovascular death and HF hospitalization. Physicians should carefully evaluate ECG findings in HFpEF patients for prognostic insights.
Area of Science:
- Cardiology
- Clinical Medicine
- Medical Diagnostics
Background:
- Electrocardiogram (ECG) is routinely used in heart failure with preserved ejection fraction (HFpEF) management.
- The prognostic implications of abnormal ECG findings in HFpEF are not fully established.
- Previous studies on ECG prognostic markers in HFpEF often had limited sample sizes.
Purpose of the Study:
- To investigate the prognostic value of baseline abnormal electrocardiograms (ECG) in patients with heart failure with preserved ejection fraction (HFpEF).
- To utilize data from the large-scale TOPCAT trial to assess ECG's predictive power for adverse cardiovascular events in HFpEF.
- To identify specific ECG abnormalities associated with poor prognosis in this patient population.
Main Methods:
- Analysis of 1736 patients from the TOPCAT-Americas cohort with heart failure with preserved ejection fraction (HFpEF).
- Patients were stratified into groups based on normal versus abnormal baseline electrocardiogram (ECG) findings.
- Survival analyses were conducted for the primary composite endpoint (cardiovascular death, HF hospitalization, aborted cardiac arrest), all-cause death, cardiovascular death, and HF hospitalization.
Main Results:
- Abnormal ECG was significantly linked to increased risk of the primary endpoint (HR: 1.480) and HF hospitalization (HR: 1.400) in HFpEF patients.
- Bundle branch block predicted the primary endpoint and HF hospitalization, while atrial fibrillation/flutter was associated with all-cause and cardiovascular death.
- Unspecified ECG abnormalities also correlated with a higher risk of the primary endpoint (HR: 1.213).
Conclusions:
- Baseline abnormal electrocardiograms (ECG) are associated with a poorer prognosis in patients with heart failure with preserved ejection fraction (HFpEF).
- Specific ECG findings like bundle branch block and atrial fibrillation have distinct prognostic implications.
- Clinicians should consider abnormal ECG findings in HFpEF patients as significant indicators of adverse outcomes.
Purpose:
Electrocardiogram (ECG) is generally performed in patients with heart failure with preserved ejection fraction (HFpEF), but the prognostic value of abnormal ECG is not fully understood. We aim to explore the prognostic value of abnormal ECG at baseline in HFpEF using data from the TOPCAT trial.
Methods:
A total of 1736 patients from TOPCAT-Americas were included and divided into normal versus abnormal ECG groups. Survival analyses were performed for the following outcomes: the primary endpoint [a composite of cardiovascular death, heart failure (HF) hospitalization, and aborted cardiac arrest], all-cause death, cardiovascular death, and HF hospitalization.
Results:
Abnormal ECG was significantly associated with higher risks of the primary endpoint [hazard ratio (HR): 1.480, P = 0.001] and HF hospitalization (HR: 1.400, P = 0.015), and borderline significantly with cardiovascular death (HR: 1.453, P = 0.052) in patients with HFpEF after multivariate adjustment. As for specific ECG abnormalities, bundle branch block was associated with the primary endpoint (HR: 1.278, P = 0.020) and HF hospitalization (HR: 1.333, P = 0.016), whereas atrial fibrillation/flutter was associated with all-cause death (HR: 1.345, P = 0.051) and cardiovascular death (HR: 1.570, P = 0.023), but ventricular paced rhythm, pathological Q waves, and left ventricular hypertrophy were not of prognostic significance. Besides, other unspecific abnormalities together were associated with the primary endpoint (HR: 1.213, P = 0.032).
Conclusion:
Abnormal ECG at baseline could be associated with poor prognosis in patients with HFpEF. Physicians are encouraged to pay more attention to HFpEF patients who present an abnormal ECG instead of ignoring those obscure abnormalities. Key messages What is already known on this topic Electrocardiogram (ECG) is a basic and easily accessible examination for patients with heart failure with preserved ejection fraction (HFpEF). Some findings from ECG such as frontal QRS-T angle, QTc interval, and the Cornell product have been shown to be associated with the prognosis of HFpEF but these results are from studies with relatively small sample sizes. What this study adds Using data from TOPCAT-Americas, this study found that an overall estimation of abnormal ECG significantly predicted poor prognosis in patients with HFpEF. As for specific abnormalities in ECG, bundle branch block mainly predicted heart failure hospitalization and atrial fibrillation mainly predicted death. How this study might affect research, practice, or policy This study reminds physicians to pay more attention to HFpEF patients who present an abnormal ECG.
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