Patients with new-onset HFrEF and QRS ≥150 ms showed significantly less LVEF recovery compared to those with QRS <120 ms (mean LVEF 37.1% vs 41.5%; p=0.038) despite optimal GDMT titration.
Observational (n=170)
No
Does QRS duration affect GDMT titration and LVEF recovery in patients with new-onset HFrEF?
In patients with new-onset HFrEF, a QRS duration ≥150 ms is associated with blunted LVEF recovery despite optimal GDMT titration, highlighting a potential need for earlier CRT consideration.
Absolute Event Rate: 37.1% vs 41.5%
p-value: p=0.038
Abstract Introduction Guideline-directed medical therapy (GDMT) is the cornerstone of heart failure with reduced ejection fraction (HFrEF) treatment, promoting left ventricular ejection fraction (LVEF) improvement. However, the impact of QRS prolongation on GMDT titration and efficacy, and LVEF recovery remains unclear. This study aims to evaluate how QRS duration affects pharmacological titration, LV functional improvement and enhanced quality of life. Methods Retrospective observational study of 170 consecutively enrolled patients with new-onset HFrEF visited in our Heart Failure Unit between March 2021 to June 2024. Patients with previous pacemaker or cardiac resynchronization therapy (CRT) implantation were excluded. Patients were stratified into three groups based on initial electrocardiographic QRS duration measured by digital caliper: 120ms, 120-149ms, and ≥150ms. Clinical, laboratory, and echocardiographic variables were collected at baseline and at the end of follow-up. The titration of guideline-directed medical therapy (GDMT) was reviewed, assessing the achievement of target doses for RAAS inhibitors (RAASi), β-blockers (BB), mineralocorticoid receptor antagonists (MRA), and SGLT2 inhibitors (SGLT2i). Mean follow-up to achieve titration was 3.98±1.1 months. Following titration, improvement of LVEF, changes in laboratory variables (NT-proBNP) and quality of life measured by Kansas City Cardiomyopathy Questionnaire (KCCQ) were assessed. Results The mean age was 62.5 years, with 17.6% of patients being female. Comorbidities were similarly distributed across groups. Ischemic heart disease was the most common etiology, while idiopathic cardiomyopathy was more prevalent in the QRS ≥150 ms group. Mean baseline LVEF was 28.79 ± 6.8% showing no significant differences among groups, in a similar way as baseline NT-proBNP levels (Table 1). There were no significant differences in the titration of GDMT across QRS groups (RAASi: p=0.47, BB: p=0.65, MRA: p=0.54, SGLT2i: p=0.63) and target doses were similarly achieved (Figure 1A). Post-titration, NT-proBNP decreased similarly across groups (p=0.99), but despite optimal GDMT titration, patients with QRS ≥150 ms showed significantly less LVEF recovery (mean LVEF: 41.5±8.8, 38.7±8.4 and 37.1±9.8 respectively; p 0.038) (Figure 1B). Patients with QRS ≥150 ms exhibited a tendency toward increased symptom burden, evidenced by a lower Kansas City Cardiomyopathy Questionnaire (KCCQ) score following treatment titration (88.3±14.2, 82.3±16.6 and 75.7±17.2 respectively, p=0.092). Conclusions Although QRS duration does not limit GDMT titration for new-onset HFrEF, patients with QRS ≥150 ms show less LV functional improvement and a trend towards worse quality of life despite optimal medical therapy. These findings suggest that initial QRS duration could help identify patients who may benefit from earlier consideration of non-pharmacological treatment and guide early intervention decisions as CRT.Table 1 Figure 1
Loriente et al. (Sat,) conducted a observational in New-onset heart failure with reduced ejection fraction (HFrEF) (n=170). Guideline-directed medical therapy (GDMT) vs. Stratification by QRS duration (<120ms, 120-149ms, ≥150ms) was evaluated on Left ventricular ejection fraction (LVEF) recovery (p=0.038). Patients with new-onset HFrEF and QRS ≥150 ms showed significantly less LVEF recovery compared to those with QRS <120 ms (mean LVEF 37.1% vs 41.5%; p=0.038) despite optimal GDMT titration.