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Impact of QRS Duration and Morphology on the Risk of Sudden Cardiac Death in Asymptomatic Patients With Aortic Stenosis The SEAS (Simvastatin and Ezetimibe in Aortic Stenosis) Study

Greve, Anders M.; Gerdts, Eva; Boman, Kurt; Gohlke-Baerwolf, Christa; Rossebo, Anne B.; Devereux, Richard B.; Kober, Lars; Ray, Simon; Willenheimer, Ronnie LU and Wachtell, Kristian (2012) In Journal of the American College of Cardiology 59(13). p.1142-1149
Abstract
Objectives The aim of the study was to examine the predictive value of QRS duration and morphology during watchful waiting in asymptomatic patients with aortic stenosis (AS). Background QRS duration and morphology are associated with poor prognosis in many different populations, but the predictive value, particularly of the risk of sudden cardiac death (SCD), in asymptomatic patients with AS has not been well studied. Methods Data were obtained in asymptomatic AS patients randomized to simvastatin/ezetimibe combination versus placebo in the SEAS (Simvastatin and Ezetimibe in Aortic Stenosis) study. The impact of QRS duration, evaluated as a categorical variable of <85 ms versus 85 to 99 ms and >= 100 ms (excluding bundle branch block... (More)
Objectives The aim of the study was to examine the predictive value of QRS duration and morphology during watchful waiting in asymptomatic patients with aortic stenosis (AS). Background QRS duration and morphology are associated with poor prognosis in many different populations, but the predictive value, particularly of the risk of sudden cardiac death (SCD), in asymptomatic patients with AS has not been well studied. Methods Data were obtained in asymptomatic AS patients randomized to simvastatin/ezetimibe combination versus placebo in the SEAS (Simvastatin and Ezetimibe in Aortic Stenosis) study. The impact of QRS duration, evaluated as a categorical variable of <85 ms versus 85 to 99 ms and >= 100 ms (excluding bundle branch block [BBB]) and QRS morphology in those with BBB, on cardiovascular morbidity and mortality was assessed by adjusting for clinical and echocardiographic covariates. Results QRS data were available in 1,542 patients who were followed for a mean of 4.3 +/- 0.8 years (6,631 patient-years of follow-up). There were 68 cardiovascular deaths (4.6%), including 27 SCDs (1.8%). QRS duration was <85 ms in 900 patients (58.4%), 85 to 99 ms in 396 (25.7%), >= 100 ms in those without BBB in 144 (9.3%), and 102 (6.6%) in those with BBB. In multivariable analyses, those with QRS duration >= 100 ms had, compared with those with QRS duration <85 ms, a 5-fold higher risk of SCD (95% confidence interval: 1.8 to 13.7, p = 0.002) and a 2.5-fold higher risk of cardiovascular death (95% confidence interval: 1.2 to 5.1, p = 0.01). Conclusions QRS duration and morphology in asymptomatic patients with AS are independently associated with a poor prognosis, particularly the risk of SCD. (Simvastatin Ezetimibe in Aortic Stenosis [SEAS]; NCT00092677) (J Am Coll Cardiol 2012; 59: 1142-9) (C) 2012 by the American College of Cardiology Foundation (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
sudden cardiac death, QRS duration, asymptomatic aortic stenosis
in
Journal of the American College of Cardiology
volume
59
issue
13
pages
1142 - 1149
publisher
Elsevier USA
external identifiers
  • wos:000301950300004
  • scopus:84858674183
ISSN
0735-1097
DOI
10.1016/j.jacc.2011.12.020
language
English
LU publication?
yes
id
2d9eded8-26a3-4281-a972-67ed602661d5 (old id 2495054)
date added to LUP
2012-05-07 13:30:02
date last changed
2017-09-24 03:10:30
@article{2d9eded8-26a3-4281-a972-67ed602661d5,
  abstract     = {Objectives The aim of the study was to examine the predictive value of QRS duration and morphology during watchful waiting in asymptomatic patients with aortic stenosis (AS). Background QRS duration and morphology are associated with poor prognosis in many different populations, but the predictive value, particularly of the risk of sudden cardiac death (SCD), in asymptomatic patients with AS has not been well studied. Methods Data were obtained in asymptomatic AS patients randomized to simvastatin/ezetimibe combination versus placebo in the SEAS (Simvastatin and Ezetimibe in Aortic Stenosis) study. The impact of QRS duration, evaluated as a categorical variable of &lt;85 ms versus 85 to 99 ms and &gt;= 100 ms (excluding bundle branch block [BBB]) and QRS morphology in those with BBB, on cardiovascular morbidity and mortality was assessed by adjusting for clinical and echocardiographic covariates. Results QRS data were available in 1,542 patients who were followed for a mean of 4.3 +/- 0.8 years (6,631 patient-years of follow-up). There were 68 cardiovascular deaths (4.6%), including 27 SCDs (1.8%). QRS duration was &lt;85 ms in 900 patients (58.4%), 85 to 99 ms in 396 (25.7%), &gt;= 100 ms in those without BBB in 144 (9.3%), and 102 (6.6%) in those with BBB. In multivariable analyses, those with QRS duration &gt;= 100 ms had, compared with those with QRS duration &lt;85 ms, a 5-fold higher risk of SCD (95% confidence interval: 1.8 to 13.7, p = 0.002) and a 2.5-fold higher risk of cardiovascular death (95% confidence interval: 1.2 to 5.1, p = 0.01). Conclusions QRS duration and morphology in asymptomatic patients with AS are independently associated with a poor prognosis, particularly the risk of SCD. (Simvastatin Ezetimibe in Aortic Stenosis [SEAS]; NCT00092677) (J Am Coll Cardiol 2012; 59: 1142-9) (C) 2012 by the American College of Cardiology Foundation},
  author       = {Greve, Anders M. and Gerdts, Eva and Boman, Kurt and Gohlke-Baerwolf, Christa and Rossebo, Anne B. and Devereux, Richard B. and Kober, Lars and Ray, Simon and Willenheimer, Ronnie and Wachtell, Kristian},
  issn         = {0735-1097},
  keyword      = {sudden cardiac death,QRS duration,asymptomatic aortic stenosis},
  language     = {eng},
  number       = {13},
  pages        = {1142--1149},
  publisher    = {Elsevier USA},
  series       = {Journal of the American College of Cardiology},
  title        = {Impact of QRS Duration and Morphology on the Risk of Sudden Cardiac Death in Asymptomatic Patients With Aortic Stenosis The SEAS (Simvastatin and Ezetimibe in Aortic Stenosis) Study},
  url          = {http://dx.doi.org/10.1016/j.jacc.2011.12.020},
  volume       = {59},
  year         = {2012},
}