Low voltage on the electrocardiogram is a marker of disease severity and a risk factor for adverse outcomes in patients with heart failure due to systolic dysfunction

Sandeep A. Kamath, Januario de P Meo Neto, Russell M. Canham, Fatema Uddin, Kathleen H. Toto, Lauren L. Nelson, Patricia A. Kaiser, James A de Lemos, Mark H Drazner

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Abstract

Background: The prognostic implications of low QRS voltage on the electrocardiogram (ECG) in heart failure (HF) are not well characterized. Methods: We manually measured and summed the QRS voltage in all 12 leads of the ECG (∑QRS) in two cohorts: (1) 415 patients with a low left ventricular ejection fraction followed up in a HF clinic ("clinic cohort") and (2) 100 subjects with advanced HF who had an ECG within 1 year preceding cardiac transplantation ("pretransplant cohort"). Low voltage was defined as the lowest quartile of the clinic cohort (∑QRS <12 mV) and its prevalence was compared in the two cohorts. The associations of low voltage with 1-year outcomes were assessed in the clinic cohort. Results: In the clinic cohort, the frequency of low voltage was higher in New York Heart Association class 4 versus class 1-3 patients (34% vs 22% respectively, P = .04). The frequency of low voltage in the pretransplant cohort (47%) was twice that of the clinic cohort (24%, P < .001). After 1 year of follow-up in the clinic cohort, low ECG voltage was associated with a higher rate of death (14% vs 5%, P = .008) and the composite end point of death or HF hospitalization (35% vs 20%, P = .004). These associations persisted in multivariable analyses adjusting for important confounders. Conclusions: Low ECG voltage is a marker of the severity of HF and is a risk factor for adverse outcomes in patients with systolic HF at 1 year.

Original languageEnglish (US)
Pages (from-to)355-361
Number of pages7
JournalAmerican Heart Journal
Volume152
Issue number2
DOIs
StatePublished - Aug 2006

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Electrocardiography
Heart Failure
Systolic Heart Failure
Heart Transplantation
Stroke Volume
Hospitalization
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Low voltage on the electrocardiogram is a marker of disease severity and a risk factor for adverse outcomes in patients with heart failure due to systolic dysfunction. / Kamath, Sandeep A.; Meo Neto, Januario de P; Canham, Russell M.; Uddin, Fatema; Toto, Kathleen H.; Nelson, Lauren L.; Kaiser, Patricia A.; de Lemos, James A; Drazner, Mark H.

In: American Heart Journal, Vol. 152, No. 2, 08.2006, p. 355-361.

Research output: Contribution to journalArticle

Kamath, Sandeep A. ; Meo Neto, Januario de P ; Canham, Russell M. ; Uddin, Fatema ; Toto, Kathleen H. ; Nelson, Lauren L. ; Kaiser, Patricia A. ; de Lemos, James A ; Drazner, Mark H. / Low voltage on the electrocardiogram is a marker of disease severity and a risk factor for adverse outcomes in patients with heart failure due to systolic dysfunction. In: American Heart Journal. 2006 ; Vol. 152, No. 2. pp. 355-361.
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AU - Meo Neto, Januario de P

AU - Canham, Russell M.

AU - Uddin, Fatema

AU - Toto, Kathleen H.

AU - Nelson, Lauren L.

AU - Kaiser, Patricia A.

AU - de Lemos, James A

AU - Drazner, Mark H

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N2 - Background: The prognostic implications of low QRS voltage on the electrocardiogram (ECG) in heart failure (HF) are not well characterized. Methods: We manually measured and summed the QRS voltage in all 12 leads of the ECG (∑QRS) in two cohorts: (1) 415 patients with a low left ventricular ejection fraction followed up in a HF clinic ("clinic cohort") and (2) 100 subjects with advanced HF who had an ECG within 1 year preceding cardiac transplantation ("pretransplant cohort"). Low voltage was defined as the lowest quartile of the clinic cohort (∑QRS <12 mV) and its prevalence was compared in the two cohorts. The associations of low voltage with 1-year outcomes were assessed in the clinic cohort. Results: In the clinic cohort, the frequency of low voltage was higher in New York Heart Association class 4 versus class 1-3 patients (34% vs 22% respectively, P = .04). The frequency of low voltage in the pretransplant cohort (47%) was twice that of the clinic cohort (24%, P < .001). After 1 year of follow-up in the clinic cohort, low ECG voltage was associated with a higher rate of death (14% vs 5%, P = .008) and the composite end point of death or HF hospitalization (35% vs 20%, P = .004). These associations persisted in multivariable analyses adjusting for important confounders. Conclusions: Low ECG voltage is a marker of the severity of HF and is a risk factor for adverse outcomes in patients with systolic HF at 1 year.

AB - Background: The prognostic implications of low QRS voltage on the electrocardiogram (ECG) in heart failure (HF) are not well characterized. Methods: We manually measured and summed the QRS voltage in all 12 leads of the ECG (∑QRS) in two cohorts: (1) 415 patients with a low left ventricular ejection fraction followed up in a HF clinic ("clinic cohort") and (2) 100 subjects with advanced HF who had an ECG within 1 year preceding cardiac transplantation ("pretransplant cohort"). Low voltage was defined as the lowest quartile of the clinic cohort (∑QRS <12 mV) and its prevalence was compared in the two cohorts. The associations of low voltage with 1-year outcomes were assessed in the clinic cohort. Results: In the clinic cohort, the frequency of low voltage was higher in New York Heart Association class 4 versus class 1-3 patients (34% vs 22% respectively, P = .04). The frequency of low voltage in the pretransplant cohort (47%) was twice that of the clinic cohort (24%, P < .001). After 1 year of follow-up in the clinic cohort, low ECG voltage was associated with a higher rate of death (14% vs 5%, P = .008) and the composite end point of death or HF hospitalization (35% vs 20%, P = .004). These associations persisted in multivariable analyses adjusting for important confounders. Conclusions: Low ECG voltage is a marker of the severity of HF and is a risk factor for adverse outcomes in patients with systolic HF at 1 year.

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