Giuseppe Coppola1, Gianfranco Ciaramitaro2, Giuseppe Stabile3, Antonio DOnofrio4, Pietro Palmisano5, Patrizia Carità2, Giosuè Mascioli6, Domenico Pecora7, Antonio De Simone8, Massimiliano Marini9, Antonio Rapacciuolo10, Gianluca Savarese11, Giampiero Maglia12, Patrizia Pepi13, Luigi Padeletti14, Attilio Pierantozzi15, Giuseppe Arena16, Tiziana Giovannini17, Salvatore Ivan Caico18, Cinzia Nugara2, Laura Ajello2, Maurizio Malacrida19, Egle Corrado2. 1. U.O.C. di Cardiologia, Policlinico Universitario "Paolo Giaccone", Palermo, Italy. Electronic address: giuseppe.coppola@unipa.it. 2. U.O.C. di Cardiologia, Policlinico Universitario "Paolo Giaccone", Palermo, Italy. 3. Clinica Mediterranea, Napoli, Italy. 4. Department of Cardiology, Monaldi Hospital, AORN Ospedali dei Colli, Napoli, Italy. 5. Cardiology Unit, 'Card. G. Panico' Hospital, Tricase, (LE), Italy. 6. Department of Cardiology, Cliniche Gavazzeni, Bergamo, Italy. 7. Fondazione Poliambulanza, Brescia, Italy. 8. Clinica San Michele, Maddaloni, (CE), Italy. 9. S. Chiara Hospital, Trento, Italy. 10. Departments of Advanced Biomedical Sciences, Federico II University of Naples, Napoli, Italy. 11. S. Giovanni Battista Hospital, Foligno, (PG), Italy. 12. Cardiology - Coronary Care Unit, Pugliese-Ciaccio Hospital, Catanzaro, Italy. 13. Carlo Poma Hospital, Mantova, Italy. 14. Cardiovascular Department, IRCCS MultiMedica, Sesto San Giovanni, (MI), Italy. 15. Division of Cardiology, S. Salvatore Hospital, Pesaro, (PU), Italy. 16. SS Giacomo e Cristoforo Hospital, UOC Cardiologia USL 1, Massa, Italy. 17. Misericordia e Dolce Hospital, Prato, Italy. 18. Sant'Antonio Abate Hospital, Gallarate, (VA), Italy. 19. Boston Scientific Italia, Milano, Italy.
Abstract
BACKGROUND: Several studies have investigated the association between native QRS duration (QRSd) or QRS narrowing and response to biventricular pacing. However, their results have been conflicting. The aim of our study was to determine the association between the relative change in QRS narrowing index (QI) and clinical outcome and prognosis in patients who undergo cardiac resynchronization therapy (CRT) implantation. METHODS AND RESULTS: We included 311 patients in whom a CRT device was implanted in accordance with current guidelines for CRT. On implantation, the native QRS, the QRSd and the QI during CRT were measured. After 6months, 220 (71%) patients showed a 10% reduction in LVESV. The median [25th-75th] QI was 14.3% [7.2-21.4] and was significantly related to reverse remodeling (r=+0.22; 95%CI: 0.11-0.32, p=0.0001). The cut-off value of QI that best predicted LV reverse remodeling after 6months of CRT was 12.5% (sensitivity=63.6%, specificity=57.1%, area under the curve=0.633, p=0.0002). The time to the event death or cardiovascular hospitalization was significantly longer among patients with QI>12.5% (log-rank test, p=0.0155), with a hazard ratio (HR) of 0.3 [95%CI: 0.11-0.78]. In the multivariate regression model adjusted for baseline parameters, a 10% increment in QI (HR=0.61[0.44-0.83], p=0.002) remained significantly associated with CRT response. CONCLUSIONS: Patients with a larger decrease in QRSd after CRT initiation showed greater echocardiographic reverse remodeling and better outcome from death or cardiovascular hospitalization. QI is an easy-to-measure variable that could be used to predict CRT response at the time of pacing site selection or pacing configuration programming.
BACKGROUND: Several studies have investigated the association between native QRS duration (QRSd) or QRS narrowing and response to biventricular pacing. However, their results have been conflicting. The aim of our study was to determine the association between the relative change in QRS narrowing index (QI) and clinical outcome and prognosis in patients who undergo cardiac resynchronization therapy (CRT) implantation. METHODS AND RESULTS: We included 311 patients in whom a CRT device was implanted in accordance with current guidelines for CRT. On implantation, the native QRS, the QRSd and the QI during CRT were measured. After 6months, 220 (71%) patients showed a 10% reduction in LVESV. The median [25th-75th] QI was 14.3% [7.2-21.4] and was significantly related to reverse remodeling (r=+0.22; 95%CI: 0.11-0.32, p=0.0001). The cut-off value of QI that best predicted LV reverse remodeling after 6months of CRT was 12.5% (sensitivity=63.6%, specificity=57.1%, area under the curve=0.633, p=0.0002). The time to the event death or cardiovascular hospitalization was significantly longer among patients with QI>12.5% (log-rank test, p=0.0155), with a hazard ratio (HR) of 0.3 [95%CI: 0.11-0.78]. In the multivariate regression model adjusted for baseline parameters, a 10% increment in QI (HR=0.61[0.44-0.83], p=0.002) remained significantly associated with CRT response. CONCLUSIONS:Patients with a larger decrease in QRSd after CRT initiation showed greater echocardiographic reverse remodeling and better outcome from death or cardiovascular hospitalization. QI is an easy-to-measure variable that could be used to predict CRT response at the time of pacing site selection or pacing configuration programming.
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