Clinical Correlates and Prognostic Value of Low QRS Voltages in Non-Ischemic Dilated Cardiomyopathy: A Retrospective Cohort Study
4 affiliations
- 1Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), 400037 Chongqing, China
- 2Department of Emergency, Xinqiao Hospital, Army Medical University (Third Military Medical University), 400037 Chongqing, China
- 3Department of Ultrasound, Xinqiao Hospital, Army Medical University (Third Military Medical University), 400037 Chongqing, China
- 4Department of Geriatrics, Southwest Hospital, Army Medical University (Third Military Medical University), 400038 Chongqing, China
Abstract
Background:: Data on the prognostic significance of low QRS voltage (LQRSV) in non-ischemic dilated cardiomyopathy (NIDCM) are limited. Therefore, this study aimed to determine whether LQRSV is associated with a composite endpoint of all-cause mortality or heart failure (HF) re-hospitalization in patients with NIDCM.
Methods:: Patients with NIDCM who met predefined criteria were retrospectively enrolled and divided into LQRSV and non-LQRSV groups based on electrocardiographic findings. The primary outcome was a composite of all-cause mortality or HF re-hospitalization. Secondary outcomes included all-cause mortality, cardiovascular (CV) death, and HF re-hospitalization. The prognostic significance of LQRSV was evaluated using Kaplan–Meier analysis and Cox proportional hazards models. Restricted cubic spline (RCS) functions were applied to examine potential nonlinear relationships between continuous QRS voltage and the primary outcome. Receiver operating characteristic (ROC) curves were used to assess predictive performance. Propensity score matching (PSM) was performed to balance baseline characteristics, and sensitivity and subgroup analyses were conducted to test the robustness of the findings.
Results:: The overall cohort included 784 consecutive patients with NIDCM (median age 56 years; 30% female). During a median follow-up of 1079 days, 335 primary outcome events occurred. After PSM, 463 patients were matched, with 186 in the LQRSV group and 277 in the non-LQRSV group. In the matched cohort, Kaplan–Meier analysis with the log-rank test showed that the LQRSV group had a significantly worse long-term prognosis than the non-LQRSV group (p < 0.001). Multivariable Cox analyses demonstrated that LQRSV was significantly associated with the composite of all-cause mortality or HF re-hospitalization (hazard ratio, (HR) 2.048, 95% confidence interval (CI) 1.519–2.760; p < 0.001), all-cause mortality (HR 2.526, 95% CI 1.660–3.844; p < 0.001), and CV death (HR 2.820, 95% CI 1.776–4.476; p < 0.001). RCS analyses showed a linear association (p for nonlinearity > 0.05), with the highest risk observed at the lowest QRS voltage amplitudes. ROC analysis revealed that incorporating LQRSV into the clinical model significantly increased the area under the curve (0.808 vs. 0.723; p < 0.001).
Conclusions:: LQRSV is associated with poor prognosis in NIDCM. Routine electrocardiographic assessment of QRS voltage may provide valuable information for risk stratification.
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BibTeX
@article{li2026clinical,
title = {{Clinical Correlates and Prognostic Value of Low QRS Voltages in Non-Ischemic Dilated Cardiomyopathy: A Retrospective Cohort Study}},
author = {Tao Li and Tingting Tian and Xiaoxue Zhang and Zhichun Gao and Lijiao Zhang and Siming Gong and Xin Deng and Moyan Qin and Yuxiao Zhang and Zhexue Qin and Xiaolin Luo},
journal = {Reviews in Cardiovascular Medicine},
year = {2026},
month = oct,
doi = {10.31083/rcm50413},
url = {https://doi.org/10.31083/rcm50413},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Clinical Correlates and Prognostic Value of Low QRS Voltages in Non-Ischemic Dilated Cardiomyopathy: A Retrospective Cohort Study
AU - Tao Li
AU - Tingting Tian
AU - Xiaoxue Zhang
AU - Zhichun Gao
AU - Lijiao Zhang
AU - Siming Gong
AU - Xin Deng
AU - Moyan Qin
AU - Yuxiao Zhang
AU - Zhexue Qin
AU - Xiaolin Luo
PY - 2026
DA - 2026/10/22
JO - Reviews in Cardiovascular Medicine
DO - 10.31083/rcm50413
UR - https://doi.org/10.31083/rcm50413
AB - Background:: Data on the prognostic significance of low QRS voltage (LQRSV) in non-ischemic dilated cardiomyopathy (NIDCM) are limited. Therefore, this study aimed to determine whether LQRSV is associated with a composite endpoint of all-cause mortality or heart failure (HF) re-hospitalization in patients with NIDCM. Methods:: Patients with NIDCM who met predefined criteria were retrospectively enrolled and divided into LQRSV and non-LQRSV groups based on electrocardiographic findings. The primary outcome was a composite of all-cause mortality or HF re-hospitalization. Secondary outcomes included all-cause mortality, cardiovascular (CV) death, and HF re-hospitalization. The prognostic significance of LQRSV was evaluated using Kaplan–Meier analysis and Cox proportional hazards models. Restricted cubic spline (RCS) functions were applied to examine potential nonlinear relationships between continuous QRS voltage and the primary outcome. Receiver operating characteristic (ROC) curves were used to assess predictive performance. Propensity score matching (PSM) was performed to balance baseline characteristics, and sensitivity and subgroup analyses were conducted to test the robustness of the findings. Results:: The overall cohort included 784 consecutive patients with NIDCM (median age 56 years; 30% female). During a median follow-up of 1079 days, 335 primary outcome events occurred. After PSM, 463 patients were matched, with 186 in the LQRSV group and 277 in the non-LQRSV group. In the matched cohort, Kaplan–Meier analysis with the log-rank test showed that the LQRSV group had a significantly worse long-term prognosis than the non-LQRSV group (p < 0.001). Multivariable Cox analyses demonstrated that LQRSV was significantly associated with the composite of all-cause mortality or HF re-hospitalization (hazard ratio, (HR) 2.048, 95% confidence interval (CI) 1.519–2.760; p < 0.001), all-cause mortality (HR 2.526, 95% CI 1.660–3.844; p < 0.001), and CV death (HR 2.820, 95% CI 1.776–4.476; p < 0.001). RCS analyses showed a linear association (p for nonlinearity > 0.05), with the highest risk observed at the lowest QRS voltage amplitudes. ROC analysis revealed that incorporating LQRSV into the clinical model significantly increased the area under the curve (0.808 vs. 0.723; p < 0.001). Conclusions:: LQRSV is associated with poor prognosis in NIDCM. Routine electrocardiographic assessment of QRS voltage may provide valuable information for risk stratification.
SN - 1530-6550
SN - 2153-8174
ER -