Electrocardiographic characteristics in patients with heart failure and normal ejection fraction: A systematic review and meta‐analysis

• Published in: Annals of noninvasive electrocardiology Vol. 25; no. 1; pp. e12710 - n/a
• Main Authors: Nikolaidou, Theodora, Samuel, Nathan A., Marincowitz, Carl, Fox, David J., Cleland, John G. F., Clark, Andrew L.
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.01.2020; John Wiley and Sons Inc
• Subjects: Abnormalities; atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - physiopathology; Cardiac arrhythmia; Congestive heart failure; ECG; Echocardiography; Ejection fraction; EKG; Electrocardiography; Electrocardiography - methods; Etiology; Fibrillation; Heart failure; Heart Failure - complications; Heart Failure - physiopathology; heart failure with normal ejection fraction; heart rhythm; Humans; Hypertrophy; Hypertrophy, Left Ventricular - complications; Hypertrophy, Left Ventricular - physiopathology; Meta-analysis; Phenotypes; Review; Reviews; Stroke Volume - physiology; Ventricle; ECG; atrial fibrillation; heart failure with normal ejection fraction; heart rhythm
• ISSN: 1082-720X; 1542-474X
• DOI: 10.1111/anec.12710

Background Little is known about ECG abnormalities in patients with heart failure and normal ejection fraction (HeFNEF) and how they relate to different etiologies or outcomes. Methods and Results We searched the literature for peer‐reviewed studies describing ECG abnormalities in HeFNEF other than heart rhythm alone. Thirty five studies were identified and 32,006 participants. ECG abnormalities reported in patients with HeFNEF include atrial fibrillation (prevalence 12%–46%), long PR interval (11%–20%), left ventricular hypertrophy (LVH, 10%–30%), pathological Q waves (11%–18%), RBBB (6%–16%), LBBB (0%–8%), and long JTc (3%–4%). Atrial fibrillation is more common in patients with HeFNEF compared to those with heart failure and reduced ejection fraction (HeFREF). In contrast, long PR interval, LVH, Q waves, LBBB, and long JTc are more common in patients with HeFREF. A pooled effect estimate analysis showed that QRS duration ≥120 ms, although uncommon (13%–19%), is associated with worse outcomes in patients with HeFNEF. Conclusions There is high variability in the prevalence of ECG abnormalities in patients with HeFNEF. Atrial fibrillation is more common in patients with HeFNEF compared to those with HeFREF. QRS duration ≥120 ms is associated with worse outcomes in patients with HeFNEF. Further studies are needed to address whether ECG abnormalities correlate with different phenotypes in HeFNEF.