Abstract 11574: Relationship Between Baseline Electrocardiographic Parameters and Outcomes in Patients With High-Risk Heart Failure With Reduced Ejection Fraction: Insights From the Vericiguat Global Study in Patients With Heart Failure With Reduced Ejection Fraction (VICTORIA) Trial

Abstract

Background: Patients with chronic heart failure with reduced ejection fraction (HFrEF) and recent decompensation are at high risk of cardiovascular (CV) events including mortality; risk stratification remains challenging. To further assess risk in this population, we characterized their baseline 12-lead ECGs and their prognostic value in 4880 patients (24% female) from the VICTORIA study. Methods: Baseline ECG parameters were interpreted in a core laboratory blinded to centrally adjudicated clinical outcomes. There were 1799 primary composite events (time to first HF hospitalization (HFH) or CV death) and 1005 total all-cause deaths (21% sudden). The MAGGIC-adjusted association between baseline ECG parameters and outcomes are presented as hazard ratio (HR) and 95% confidence intervals (CIs). Results: Incidence rates of baseline ECG parameters and their association with all-cause death and the primary composite outcome are shown below. The median MAGGIC score was 24 (19, 28) points. Higher heart rate, greater QRS duration, and prolonged QTc were significantly associated with the primary composite and all-cause death ( Table ), as well as for CV death ([HR 1.04, 95% CI 1.02-1.07; p<0.001] [HR 1.02, 1.00-1.04; p=0.015] [HR 1.16, 1.00-1.34; p=0.049]), respectively. Sex-based interactions were evident for contiguous Q waves on all-cause death (male: HR 0.98, 0.82-1.17; female: HR 1.56, 1.15-2.12; interaction p=0.010) and CV death (male: HR 1.03, 0.85-1.25; female: HR 1.66, 1.17-2.34; interaction p=0.019). Additionally, contiguous Q-waves were associated with sudden death (HR 1.45, 1.05-2.00; p=0.022) and appeared to double the risk in females (male: HR 1.25, 0.87-1.79; female: HR 2.50, 1.23-5.06; interaction p= 0.087). Conclusion: Routine ECG parameters are associated with worse outcomes in high risk HFrEF patients—particularly in females with contiguous Q waves.