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Introduction: Electrocardiographic QRS duration (QRSd) is a marker of electrical remodeling in heart failure with reduced ejection fraction (HFrEF). Differences in anthropometrics and left ventricular size have been postulated to contribute to variation of QRSd with sex, race, obesity, and sex-based response to resynchronization therapy. We controlled QRSd for body size as electroanatomic ratios and assessed their association with mortality. Hypothesis: We hypothesized that electrical remodeling quantified as increased electroanatomic ratios are associated with increased mortality. Methods: The Asian Sudden Cardiac Death in Heart Failure (ASIAN-HF) registry prospectively followed symptomatic HFrEF patients from 11 Asian regions. Electroanatomic ratios were derived as ratios of QRSd to body size (height; body surface area, BSA; body mass index, BMI). Cox proportional hazard models were used to assess the association between electroanatomic ratio and 1-year all-cause mortality. Results: The study included 4899 eligible patients (age 60±19 years, 78% male, LVEF 27.3±7.1 %, 50% ischemic etiology, 35% NYHA III/IV, QRSd 115.2±32.6 ms, height 164±8.9 cm, BSA 1.74±0.23 m2, BMI 24.9±5.1 kg/m2, LVEDV 178.7±65.5 mL). QRSd was not associated with mortality (p=0.142). However, QRSd indexed for body size was independently associated with mortality (QRS/BMI: HR 1.18, 95%CI 1.06-1.31, p=0.002; QRS/BSA: HR 1.17, 95%CI 1.05-1.31, p=0.005; QRS/height: HR 1.17, 95%CI 1.05-1.30, p=0.005). Sex-based differences were seen. QRS/BSA (interaction p=0.020 with sex) was associated with mortality in men (HR 1.21, 95% CI 1.07-1.37, p=0.003) but not in women (p=0.568). QRS/height (Interaction p=0.020 with sex) was associated with mortality in men (HR 1.20, 95% CI 1.07-1.36, p=0.003) but not in women (p=0.568). Conclusions: Electroanatomic ratios of QRS/BSA, QRS/BMI and QRS/height were independently associated with mortality in patients with HFrEF whereas QRSd alone was not. Sex modified association of QRSd indexed for body size with mortality. These findings merit further investigation. [ABSTRACT FROM AUTHOR]

Introduction: The clinical and echocardiographic correlates of atrial fibrillation (AF) among patients with heart failure and preserved versus reduced ejection fraction (HFpEF vs HFrEF) have not been not well studied in Asia. Hypothesis: There are regional differences in AF among Asian patients with HF. Methods: A total of 4541 patients with HFrEF (EF<40%) and 963 patients with HFpEF (EF≥50%) were enrolled from Northeast Asia (Korea, Japan, Taiwan, Hong Kong, and China), South Asia (India) and Southeast Asia (Thailand, Malaysia, Philippines, Indonesia, Singapore) in the prospective Asian Sudden Cardiac Death in Heart Failure (ASIAN-HF) study. AF was defined by history or baseline ECG. Outcomes (death or hospitalisation) were independently adjudicated. Results: Prevalence of AF was 22% in HFrEF (mean age 60±13, 78% male) and 38% in HFpEF (mean age 68±12, 47% male). Clinical correlates that differentially associated with AF in HFpEF vs HFrEF included age, region, and chronic kidney disease; whereas echocardiographic correlates that differentially associated with AF in HFpEF vs HFrEF included left atrial volume (Figure 1A). South Asians had the lowest prevalence of AF (6%, 12% in HFrEF, HFpEF) compared to Northeast Asians (39%, 49%) and Southeast Asians (21%, 37%)(p<0.001). Odds of AF were higher in Northeast Asians (adjusted OR 2.07, 95% CI 1.79-2.40) and lower in South Asians (adjusted OR 0.23, 95% CI 0.18-0.30) when compared to Southeast Asians. Differential odds of AF by region were mediated by both clinical and echocardiographic correlates (Figure 1B). There were striking differences in ethnic associations by region, where Indians from Southeast Asia had a higher odds of AF than Indians from South Asia (OR 2.49, 95% CI 1.68-3.70), and Chinese from Southeast Asia had lower odds of AF than Chinese from Northeast Asia (OR 0.80, 95% CI 0.66-0.98). AF increased the risk of the composite outcome of all-cause mortality and HF hospitalisations (adjusted OR 1.28, 95% CI 1.09-1.51), with similar prognostic impact in HFpEF and HFrEF (Pinteraction0.39). Conclusions: These findings highlight the regional differences in AF among Asian patients with HF. South Asians with HF have a strikingly low prevalence of AF, a difference deserving of further study. [ABSTRACT FROM AUTHOR]