PURPOSE Electrocardiogram (ECG) is generally performed in patients with heart failure with preserved ejection fraction (HFpEF), but the prognostic value of abnormal ECG is not fully understood. We aim to explore the prognostic value of abnormal ECG at baseline in HFpEF using data from the TOPCAT trial. METHODS A total of 1736 patients from TOPCAT-Americas were included and divided into normal versus abnormal ECG groups. Survival analyses were performed for the following outcomes: the primary endpoint [a composite of cardiovascular death, heart failure (HF) hospitalization, and aborted cardiac arrest], all-cause death, cardiovascular death, and HF hospitalization. RESULTS Abnormal ECG was significantly associated with higher risks of the primary endpoint [hazard ratio (HR): 1.480, P = 0.001] and HF hospitalization (HR: 1.400, P = 0.015), and borderline significantly with cardiovascular death (HR: 1.453, P = 0.052) in patients with HFpEF after multivariate adjustment. As for specific ECG abnormalities, bundle branch block was associated with the primary endpoint (HR: 1.278, P = 0.020) and HF hospitalization (HR: 1.333, P = 0.016), whereas atrial fibrillation/flutter was associated with all-cause death (HR: 1.345, P = 0.051) and cardiovascular death (HR: 1.570, P = 0.023), but ventricular paced rhythm, pathological Q waves, and left ventricular hypertrophy were not of prognostic significance. Besides, other unspecific abnormalities together were associated with the primary endpoint (HR: 1.213, P = 0.032). CONCLUSION Abnormal ECG at baseline could be associated with poor prognosis in patients with HFpEF. Physicians are encouraged to pay more attention to HFpEF patients who present an abnormal ECG instead of ignoring those obscure abnormalities. KEY MESSAGES

中文翻译：

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射血分数保留的心力衰竭心电图异常和预后不良。

目的 心电图 (ECG) 通常在射血分数保留的心力衰竭 (HFpEF) 患者中进行，但异常心电图的预后价值尚不完全清楚。我们的目的是利用 TOPCAT 试验的数据探讨 HFpEF 基线心电图异常的预后价值。方法 共有 1736 名来自 TOPCAT-Americas 的患者被纳入研究，并将其分为正常心电图组和异常心电图组。对以下结局进行生存分析：主要终点[心血管死亡、心力衰竭 (HF) 住院和心脏骤停中止的复合终点]、全因死亡、心血管死亡和心力衰竭住院。结果心电图异常与主要终点风险较高[风险比 (HR)：1.480，P = 0.001] 和心衰住院（HR：1.400，P = 0.015）显着相关。多变量调整后，HFpEF 患者与心血管死亡显着相关（HR：1.453，P = 0.052）。至于特定的心电图异常，束支传导阻滞与主要终点（HR：1.278，P = 0.020）和心衰住院（HR：1.333，P = 0.016）相关，而心房颤动/扑动与全因死亡相关（ HR：1.345，P = 0.051）和心血管死亡（HR：1.570，P = 0.023），但心室起搏节律、病理性Q波和左心室肥厚不具有预后意义。此外，其他非特异性异常与主要终点相关（HR：1.213，P = 0.032）。结论 基线心电图异常可能与 HFpEF 患者预后不良相关。鼓励医生更多地关注心电图异常的 HFpEF 患者，而不是忽视那些不起眼的异常。关键信息