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Original Research: PULMONARY VASCULAR DISEASE |

Prolonged QRS DurationProlonged QRS Duration Predicts Adverse Outcome: A New Predictor of Adverse Outcome in Idiopathic Pulmonary Arterial Hypertension

Pei-Yu Sun, MD; Xin Jiang, MD; Mardi Gomberg-Maitland, MD, FCCP; Qin-Hua Zhao, MD; Jing He, MD; Ping Yuan, MD; Rui Zhang, MD; Zhi-Cheng Jing, MD, FCCP
Author and Funding Information

From the Department of Cardio-Pulmonary Circulation (Drs Sun, Jiang, Zhao, He, Yuan, Zhang, and Jing), Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China; and the Section of Cardiology, Department of Medicine (Dr Gomberg-Maitland), University of Chicago Medical Center, Chicago, IL.

Correspondence to: Zhi-Cheng Jing, MD, FCCP, Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507, Zhengmin Rd, Shanghai 200433, China; e-mail: jingzhicheng@gmail.com


Drs Sun and Jiang contributed equally to this article.

Funding/Support: This study was sponsored by the China National 973 Project [Grant 2007CB512008] and the Shanghai Science and Technology Division of non-Governmental International Cooperation Projects [Grant 08410701600].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(2):374-380. doi:10.1378/chest.10-3331
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Background:  A prolonged QRS duration ( ≥ 120 milliseconds) predicts outcomes in patients with left-sided heart failure, but the impact in idiopathic pulmonary arterial hypertension (IPAH) and right-sided heart failure is unknown. We assessed the prognostic value of a prolonged ECG QRS duration in patients with IPAH in China.

Methods:  We retrospectively analyzed the initial 12-lead ECG for QRS duration in 212 consecutive patients with IPAH seen at our center between 2007 and 2009. Patients were divided according to QRS duration < 120 milliseconds or ≥ 120 milliseconds. The baseline characteristics and survival of the two groups were compared.

Results:  Thirty-five patients with IPAH (16.5%) had a QRS duration ≥ 120 milliseconds, including 21 (9.9%) with right bundle-branch block and 14 (6.6%) with nonspecific intraventricular conduction delay. Prolongation of the QRS duration was associated with a worse World Health Organization functional class and 6-min walk test distance and higher serum uric acid when compared with patients with normal QRS duration (P < .05). Prolonged QRS duration was an independent predictor of mortality and was associated with a 2.5-fold increased risk of death (P = .024).

Conclusion:  Prolongation of the QRS duration is associated with clinical severity in patients with IPAH. In addition, QRS prolongation has an independent association with cardiopulmonary mortality and could be a new predictor of adverse outcome in patients with IPAH.

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