Prolonged QRS duration was defined as QRS ≥110 ms and intraventricular conduction delay as QRS ≥110 ms, without the criteria of complete or incomplete bundle-branch block. Primary end points were all-cause mortality, cardiac mortality, and arrhythmic death. We evaluated the 12-lead ECGs of 10 899 Finnish middle-aged subjects from the general population (52% of whom were men mean age 44☘.5 years) between 19 and followed them for 30☑1 years. Customer Service and Ordering Information.About Circ: Arrhythmia and Electrophysiology.Stroke: Vascular and Interventional Neurology.Journal of the American Heart Association (JAHA).Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB).“Putting these delays in the same risk category as diabetes and coronary artery disease is a significant change in practice and allows us to identify and manage previously undetected risk in our patients.” Sep. “Delays in left ventricular conduction are fairly common ECG findings,” says Steven Nissen, MD, Chief Academic Officer of Cleveland Clinic’s Miller Family Heart & Vascular Institute and principal investigator of the overall PRECISION trial. “It was the prolongation itself - not necessarily its length - that conferred increased mortality risk.” “What is striking about these findings is that it didn’t matter how long QRS was prolonged,” notes Oussama Wazni, MD, Section Head of Electrophysiology and Pacing. Patients with O-IVCD mirrored those with RBBB and narrow QRS, and L-IVCD survival tracked with LBBB. The researchers’ IVCD classification scheme also proved valid for mortality stratification, although it needs further validation in additional cohorts. Patients’ cardiovascular disease status and QRS duration did not affect results. Overall LCVD was associated with greater all-cause mortality (adjusted HR = 2.8, P < 0.001) and cardiovascular mortality (adjusted HR = 3.6, P < 0.001) than were observed risks of LV hypertrophy, diabetes and coronary artery disease. 161 (0.7%) had IVCD, with 95 (0.4%) subclassified as L-IVCDĪfter multivariable adjustment, analysis showed that LBBB and L-IVCD were both associated with an increased hazard ratio (HR) for all-cause and cardiovascular mortality, as follows:.Of the overall sample, 1,240 patients (5.6%) had QRS prolongation and broke down as follows: Outcomes measured were all-cause and cardiovascular mortality, with HF hospitalization a secondary outcome. Twenty-three percent had established cardiovascular disease, and arthritis type was adjusted for in multivariate analysis. Mean age was 63 years, and 64% of patients were female. Subjects without these findings were categorized as non-LBBB-predominant (O-IVCD).Īverage follow-up was 34 ± 13 months. IVCD with LBBB-predominant features (L-IVCD) required the following ECG findings: (1) lead V1 net negative (2) lead V1 without terminal positivity and (3) lead I net positive. The researchers devised a first-of-kind subclassification scheme for IVCD. IVCD was defined overall as QRS 101 to 120 ms irrespective of morphology, or as QRS > 120 ms not identifiable as BBB. LBBB and RBBB were identified according to standard definitions (QRS duration > 120 ms). The present study categorized QRS duration as narrow (≤ 100 ms) or prolonged (> 100 ms), with prolongation further classified into LBBB, right bundle branch block (RBBB) and intraventricular conduction delay (IVCD). The Cleveland Clinic Coordinating Center for Clinical Research ( C5Research) adjudicated all-cause and cardiovascular mortality as well as heart failure (HF) hospitalizations and ECG results.
Patients enrolled underwent a baseline 12-lead ECG. PRECISION found in 2016 that celecoxib does not confer excess cardiovascular risk and is associated with fewer cardiovascular adverse events compared with both naproxen and ibuprofen in patients with rheumatoid arthritis or osteoarthritis.
This post hoc analysis included 22,607 (94%) of the randomized, double-blind, multicenter PRECISION trial’s 24,081 patients. “Our analysis makes a strong case for recognizing any type of delayed LV conduction among well-recognized cardiovascular risk factors, and thus changing how we think about overall cardiovascular health.” New subclassification scheme for intraventricular conduction delay “We have long established that delayed left ventricular conduction in the form of left bundle branch block confers markedly increased risk for cardiovascular and overall mortality in patients,” says the study’s corresponding and senior author, Daniel Cantillon, MD, of Cleveland Clinic’s Section of Electrophysiology and Pacing. We do not endorse non-Cleveland Clinic products or services Policy Advertising on our site helps support our mission. Cleveland Clinic is a non-profit academic medical center.