The prognostic value of ECG and right heart catheterization parameters in heart failure patients with reduced ejection fraction

Introduction:
Electrocardiographic (ECG) markers such as the Tpeak-Tend interval (Tpe), QRS interval, and fragmented QRS (fQRS) are increasingly recognized as predictors of clinical outcomes in heart failure patients with reduced ejection fraction (HFrEF). However, the association of these ECG markers with invasive hemodynamic parameters remains underexplored.

Aim:
The primary objective of this study is to assess the prognostic value of ECG parameters in patients with HFrEF. The secondary aim is to investigate the relationship between ECG markers (Tpe, QRS interval, and fQRS) and invasive hemodynamic parameters in these patients.

Material and methods:
A total of 325 patients with HFrEF who underwent right heart catheterization between January 2007 and January 2017 were included in this cross-sectional study. The primary end-points were defined as all-cause mortality and composite end-point (CEP) (recently undergone heart transplant surgery, mechanical circulatory support, and all-cause mortality).

Results:
During a median follow-up of 28.1 months, all-cause mortality was observed in 138 patients. Patients with CEP (n = 156) had longer QRS, Tpe intervals, and a greater number of fQRS complexes (p < 0.05). Prolonged QRS and Tpe intervals showed significant correlations with elevated pulmonary artery pressures and reduced cardiac output (p < 0.05). Every one ms increase in Tpe and QRS intervals was associated with a 3% and 5% increase in CEP, respectively. Tpe and QRS intervals were found to be independent predictors of CEP and all-cause mortality in patients with HFrEF.

Conclusions:
Tpe and QRS intervals provide valuable information regarding the hemodynamic status and prognosis in patients with HFrEF. These simple ECG parameters may serve as noninvasive tools for risk stratification and aid in clinical decision-making in this high-risk population.