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CLINICAL RESEARCH: VENTRICULAR DYSSYNCHRONY

Cross-sectional relations of electrocardiographic QRS duration to left ventricular dimensions

The Framingham Heart Study

Ravi Dhingra, MD^*,, Byung Ho Nam, PhD^*,||, Emelia J. Benjamin, MD, ScM, FACC^*,¶, Thomas J. Wang, MD^*,, Martin G. Larson, ScD^*,¶, Ralph B. D'Agostino, Sr, PhD^*,||, Daniel Levy, MD, FACC^*,,¶ and Ramachandran S. Vasan, MD, FACC^*,¶,*

^* Framingham Heart Study, Framingham, Massachusetts
Veterans Affairs Boston Healthcare System, Boston, Massachusetts
National Heart, Lung and Blood Institute, Bethesda, Maryland
Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
^|| Department of Mathematics, Boston University, Boston, Massachusetts
^¶ Department of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts

Manuscript received September 18, 2004; revised manuscript received November 11, 2004, accepted November 15, 2004.

^* Reprint requests and correspondence: Dr. Ramachandran S. Vasan, Framingham Heart Study, 73 Mount Wayte Avenue, Suite 2, Framingham, Massachusetts 01702-5803. (Email: vasan{at}bu.edu).

OBJECTIVES: The goal of this study was to assess the relations of electrocardiographic QRS duration to left ventricular (LV) measurements in individuals without heart failure (HF) or prior myocardial infarction (MI).

BACKGROUND: Increased electrocardiographic QRS duration (120 ms) is a marker of ventricular dyssynchrony.

METHODS: We evaluated the relations of maximal electrocardiographic QRS duration to echocardiographic LV dimensions in 4,534 Framingham Heart study participants (mean age 54 years, 57% women) without prior HF or MI. QRS duration was analyzed as a continuous variable and as categories (<100, 100 to 119, and 120 ms).

RESULTS: In linear regression models, LV mass, end-diastolic dimension, and septal and posterior wall thicknesses were positively related to log-QRS duration, whereas fractional shortening (FS) was inversely related (p < 0.001). There was a significant trend for increasing LV mass and dimensions, and decreasing FS across categories of QRS duration (p < 0.001). Left bundle branch block was associated with higher LV mass and lower FS compared with a normal QRS duration (p < 0.001).

CONCLUSIONS: In our community-based sample of individuals free of HF and MI, increasing electrocardiographic QRS duration was positively related to LV mass and dimensions, and inversely associated with LV FS. Additional investigations are warranted to elucidate the mechanisms underlying the observed associations.

Abbreviations and Acronyms   BBB = bundle branch block   FS = fractional shortening   HF = heart failure   IVS = interventricular septum at end-diastole   LA = left atrial size at end-systole   LBBB = left bundle branch block   LV = left ventricle/ventricular   LVDD = left ventricular internal dimensions in diastole   LVDS = left ventricular internal dimensions in systole   MI = myocardial infarction   PW = posterior wall   RBBB = right bundle branch block

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