Chest
Original ResearchPulmonary Vascular DiseaseProlonged QRS Duration: A New Predictor of Adverse Outcome in Idiopathic Pulmonary Arterial Hypertension
Section snippets
Patients
We investigated 234 consecutive incident patients in whom IPAH was diagnosed at our institute between January 1, 2007 and September 30, 2009. All were inpatients and were diagnosed by right-sided heart catheterization according to standard criteria: a mean pulmonary artery pressure (mPAP) ≥ 25 mm Hg and PVR > 3 Wood units at rest in the presence of a normal pulmonary capillary wedge pressure (≤ 15 mm Hg).16 Patients with PAH associated with a definite cause, such as connective tissue disease
Incidence of Prolonged QRS Duration
A total of 212 patients with IPAH (mean age 34.3 ± 15.8 years; 71.7% female) who fulfilled the inclusion criteria were included in the study. A prolonged QRS complex was present in 35 patients (16.5%), including 21 (9.9%) with right bundle-branch block (RBBB) and 14 (6.6%) with nonspecific intraventricular conduction delay (IVCD). The incidence of prolonged QRS duration increased in proportion to the severity of the WHO functional class ranking. Patients in WHO functional classes III and IV had
Discussion
Acute and chronic right-sided HF occur in patients with IPAH, and prognostically RV function is a major determinant of functional capacity and prognosis.10 The compensatory ability of the RV is quite variable among individuals, the reasons for which are still unknown. Our study mirrors the early results in left-sided HF that indicated that a prolonged QRS duration ≥ 120 milliseconds in patients with IPAH predicts worse outcomes.
In left-sided HF, a prolonged QRS duration ≥ 120 milliseconds is
Acknowledgments
Author contributions: Dr Sun: contributed to the conception and design; data acquisition, analysis, and interpretation; drafting of the manuscript; and statistical analysis.
Dr Jiang: contributed to the conception and design; data acquisition, analysis, and interpretation; drafting of the manuscript; and statistical analysis.
Dr Gomberg-Maitland: contributed to the data acquisition, analysis, and interpretation and critical revision of the manuscript for important intellectual content.
Dr Zhao:
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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).
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Drs Sun and Jiang contributed equally to this article.