QRS Duration and Early Hemodynamic Instability After Coronary Revascularization Surgery

• Published in: Revista española de cardiología (English ed.) 2009-06, Vol.62 (6), p.652-659
• Main Authors: Arribas Leal, José M., Pascual-Figal, Domingo A., Vidal, Miguel Ahumada, Ortuño, Francisco Marín, García, Francisco Gutiérrez, del Corral, Julio García-Puente, Ruipérez Abizanda, Juan A., Martínez, Ginés Torres, Chávarri, Mariano Valdés, Meca, Ramón Arcas
• Format: Article
• Language: English
• Subjects: Cirugía coronaria; Coronary surgery; ECG; Hemodynamic instability; Inestabilidad hemodinámica; Intervalo QRS; Prognosis; Pronóstico; QRS interval
• ISSN: 1885-5857; 1885-5857
• DOI: 10.1016/S1885-5857(09)72229-7

The duration of the QRS interval measured by ECG is a marker of ventricular dysfunction and indicates a poor prognosis. Its value in patients undergoing coronary revascularization surgery has not been established. The study involved 203 consecutive patients (age, 64[9] years; 74% male) scheduled for elective coronary surgery. The maximum QRS duration measured on a preoperative 12-lead ECG was recorded. Hemodynamic instability was defined as the occurrence of cardiac death, heart failure, or a need for intravenous inotropic drugs or intra-aortic balloon counterpulsation during the postoperative period. The occurrence of hemodynamic instability (n=94, 46%) was associated with a longer preoperative QRS duration (97.5[21.14] ms vs 88.5[16.9] ms; P=.001). The QRS duration was also longer in patients who developed heart failure (n=23; 104.3[22.9] ms vs 91.1[18.5] ms; P=.002), needed inotropic drugs (n=77; 96.5[20.5] ms vs 90.1[18.2] ms; P=.007) or developed postoperative atrial fibrillation (n=58; 98.2[23.8] ms vs 90.4[17.0] ms; P=.018). Bundle branch block was associated with a greater need for intra-aortic balloon counterpulsation (29% vs 12%; P=.012) or inotropic drugs (58% vs 35%; P=.014) and a higher incidence of hemodynamic instability (69% vs 42%; P=.006). Multivariate analysis identified the following independent predictors of hemodynamic instability: QRS duration (adjusted odds ratio [OR] per 10 ms=1.49; 95% confidence interval [CI], 1.11-2; P=.007), the lack of an arterial graft (OR=3.6; 95% CI, 1.14-11.6; P=.029) and extracorporeal circulation time (OR per min=1.013; 95% CI, 1.003-1.023; P=.013). The intraventricular conduction delay, or QRS duration, was associated with a higher risk of postoperative hemodynamic instability following coronary surgery. La duración del intervalo QRS en el ECG es un marcador de disfunción ventricular y peor pronóstico. Su valor en pacientes sometidos a cirugía de revascularización coronaria no ha sido establecido. Estudiamos a 203 pacientes consecutivos (64 ± 9 años de edad; el 74% varones) programados para cirugía electiva coronaria. Se registró la duración máxima del intervalo QRS en el ECG de 12 derivaciones preoperatorio. Definimos inestabilidad hemodinámica como la aparición de muerte cardiaca, insuficiencia cardiaca, uso de fármacos inotrópicos intravenosos o balón de contrapulsación intraaórtico durante el postoperatorio. La aparición de inestabilidad hemodinámica (n = 94 [46%]) se asoció a una mayor duración del