Abstract 16638: Effect of Eplerenone According to Qrs Duration and Morphology in Emphasis-HF
Background: The importance of QRS duration (QRSd) and QRS morphology (left and right bundle-branch block [LBBB, RBBB], interventricular conduction defect [IVCD]) as predictors of prognosis and value in selecting patients for device therapy is increasingly recognized. We examined the effect of eplerenone in heart failure with reduced ejection fraction (HF-REF), according to QRSd/morphology in EMPHASIS-HF.
Methods: Patients were categorized as: QRSd (msec) a) <120 (n=1375), b) 120-149 (n=517) and c) 150+ (n=383) and QRS morphology i) normal (n=1252), ii) RBBB/IVCD (n=415) and iii) LBBB (n=608); 462 patients were excluded because of missing or incorrect ECG data. Occurrence of the primary composite outcome of cardiovascular death or heart failure hospitalization was estimated in patients randomized to placebo or eplerenone. The effect of eplerenone was adjusted for the previously described predictors of the primary outcome in EMPHASIS-HF.
Results: Both prolonged QRSd and abnormal QRS morphology were associated with increased risk. Eplerenone reduced the risk of the primary outcome, compared with placebo, in all patients (n=2275) with ECG data (HR 0.71, 95% CI 0.60-0.84 p<0.001) and this beneficial effect was consistent across QRSd and QRS morphology subgroups (Table).
Conclusion: We confirmed the association between QRS prolongation and adverse outcomes in HF-REF. Eplerenone was similarly effective, irrespective of QRSd and morphology.
Author Disclosures: J. Cannon: None. T. Collier: None. K. Swedberg: None. H. Krum: None. D.J. van Veldhuisen: None. J. Vincent: Employment; Significant; Employment with Pfizer. S. Pocock: None. B. Pitt: None. F. Zannad: None. J. McMurray: None.
- © 2014 by American Heart Association, Inc.