Clinical impact of left and right axis deviations with narrow QRS complex on 3-year outcomes in a hospital-based population in Japan

• Published in: Scientific reports Vol. 11; no. 1; p. 8892
• Main Authors: Seko, Yuta, Kato, Takao, Yamaji, Yuhei, Haruna, Yoshisumi, Nakane, Eisaku, Haruna, Tetsuya, Inoko, Moriaki
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 26.04.2021; Nature Publishing Group; Nature Portfolio
• Subjects: 692/308; 692/308/409; 692/4019; Body mass index; Cardiovascular disease; Codes; Diabetes; Echocardiography; Ejection fraction; EKG; Electrocardiography; Electronic health records; Heart attacks; Hospitals; Humanities and Social Sciences; Hypertension; Kidney diseases; Medical records; multidisciplinary; Pacemakers; Patients; Physiology; Population; Population studies; Science; Science (multidisciplinary); Variance analysis; Japan
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-021-88259-8

While the prognostic impact of QRS axis deviation has been assessed, it has never been investigated in patients without conduction block. Thus, we evaluated the prognostic impact of QRS-axis deviation in patients without conduction block. We retrospectively analyzed 3353 patients who had undergone both scheduled transthoracic echocardiography and electrocardiography in 2013 in a hospital-based population, after excluding patients with a QRS duration of ≥ 110 ms, pacemaker placement, and an QRS-axis − 90° to − 180° (northwest axis). The study population was categorized into three groups depending on the mean frontal plane QRS axis as follows: patients with left axis deviation (N = 171), those with right axis deviation (N = 94), and those with normal axis (N = 3088). The primary outcome was a composite of all-cause death and major adverse cardiovascular events. The cumulative 3-year incidence of the primary outcome measure was significantly higher in the left axis deviation group (26.4% in the left axis deviation, 22.7% in the right axis deviation, and 18.4% in the normal axis groups, log-rank P = 0.004). After adjusting for confounders, the excess risk of primary outcome measure remained significant in the left axis deviation group (hazard ratio [HR] 1.44; 95% confidence interval [CI] 1.07–1.95; P = 0.02), while the excess risk of primary outcome measure was not significant in the right axis deviation group (HR 1.22; 95% CI 0.76–1.96; P = 0.41). Left axis deviation was associated with a higher risk of a composite of all-cause death and major adverse cardiovascular events in hospital-based patients without conduction block in Japan.