TY - JOUR
T1 - QRS Area Is a Strong Determinant of Outcome in Cardiac Resynchronization Therapy
AU - van Stipdonk, Antonius M W
AU - Ter Horst, Iris
AU - Kloosterman, Marielle
AU - Engels, Elien B
AU - Rienstra, Michiel
AU - Crijns, Harry J G M
AU - Vos, Marc A
AU - van Gelder, Isabelle C
AU - Prinzen, Frits W
AU - Meine, Mathias
AU - Maass, Alexander H
AU - Vernooy, Kevin
N1 - Copyright:
This record is sourced from MEDLINE/PubMed, a database of the U.S. National Library of Medicine
PY - 2018/12
Y1 - 2018/12
N2 - BACKGROUND: The combination of left bundle branch block (LBBB) morphology and QRS duration is currently used to select patients for cardiac resynchronization therapy (CRT). These parameters, however, have limitations. This study evaluates the value of QRS area compared with that of QRS duration and morphology in the association with clinical and echocardiographic outcomes in a large cohort of CRT patients.METHODS: A retrospective multicentre study was conducted in 1492 CRT patients. LBBB morphology, QRS duration, and QRS area in the baseline 12-lead ECG were evaluated for their association with the occurrence of the combined primary end point of all-cause mortality, cardiac transplantation, and left ventricular assist device implantation. Secondary end points were heart failure hospitalization within the first year after implantation and echocardiographic reduction in left ventricular end-systolic volume.RESULTS: During a mean follow-up period of 3.4 years, 32% of patients reached the primary end point. The association of QRS area with all outcomes was stronger than that of LBBB morphology and QRS duration separately and at least as strong as their combination. QRS area identified patients who did not experience the primary end point better than QRS morphology and QRS duration (area under the curve, 0.61 versus 0.55 and 0.51, respectively; P<0.001). Furthermore, QRS area identifies patients with echocardiographic remodeling in response to CRT better than QRS morphology and duration (area under the curve, 0.69 versus 0.58 and 0.58, respectively; P<0.001). QRS area was the only independent electrocardiographic determinant associated with the primary end point; hazard ratio, 0.50 (0.35-0.71). Furthermore, QRS area showed significant association with outcomes in both patients with and without LBBB and QRS ≥150 ms.CONCLUSIONS: QRS area has a strong association to clinical and echocardiographic response to CRT, at least as strong as current patient selection parameters. QRS area may be particularly useful to predict CRT response in patients without a wide LBBB.
AB - BACKGROUND: The combination of left bundle branch block (LBBB) morphology and QRS duration is currently used to select patients for cardiac resynchronization therapy (CRT). These parameters, however, have limitations. This study evaluates the value of QRS area compared with that of QRS duration and morphology in the association with clinical and echocardiographic outcomes in a large cohort of CRT patients.METHODS: A retrospective multicentre study was conducted in 1492 CRT patients. LBBB morphology, QRS duration, and QRS area in the baseline 12-lead ECG were evaluated for their association with the occurrence of the combined primary end point of all-cause mortality, cardiac transplantation, and left ventricular assist device implantation. Secondary end points were heart failure hospitalization within the first year after implantation and echocardiographic reduction in left ventricular end-systolic volume.RESULTS: During a mean follow-up period of 3.4 years, 32% of patients reached the primary end point. The association of QRS area with all outcomes was stronger than that of LBBB morphology and QRS duration separately and at least as strong as their combination. QRS area identified patients who did not experience the primary end point better than QRS morphology and QRS duration (area under the curve, 0.61 versus 0.55 and 0.51, respectively; P<0.001). Furthermore, QRS area identifies patients with echocardiographic remodeling in response to CRT better than QRS morphology and duration (area under the curve, 0.69 versus 0.58 and 0.58, respectively; P<0.001). QRS area was the only independent electrocardiographic determinant associated with the primary end point; hazard ratio, 0.50 (0.35-0.71). Furthermore, QRS area showed significant association with outcomes in both patients with and without LBBB and QRS ≥150 ms.CONCLUSIONS: QRS area has a strong association to clinical and echocardiographic response to CRT, at least as strong as current patient selection parameters. QRS area may be particularly useful to predict CRT response in patients without a wide LBBB.
KW - bundle-branch block
KW - cardiac resynchronization therapy
KW - heart failure
KW - patient selection
KW - stroke volume
UR - http://www.scopus.com/inward/record.url?scp=85058608208&partnerID=8YFLogxK
U2 - 10.1161/CIRCEP.118.006497
DO - 10.1161/CIRCEP.118.006497
M3 - Article
C2 - 30541356
SN - 1941-3149
VL - 11
JO - Circulation. Arrhythmia and Electrophysiology
JF - Circulation. Arrhythmia and Electrophysiology
IS - 12
M1 - e006497
ER -