Kasper Emerek1, Daniel J Friedman2, Peter Lyngø Sørensen3, Steen Møller Hansen4, Jacob Moesgaard Larsen5, Niels Risum6, Anna Margrethe Thøgersen5, Claus Graff3, Joseph Kisslo2, Peter Søgaard7, Brett D Atwater2. 1. Department of Medicine, Division of Cardiology, Duke University Hospital, Durham, North Carolina; Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark. Electronic address: kjge@rn.dk. 2. Department of Medicine, Division of Cardiology, Duke University Hospital, Durham, North Carolina. 3. Department of Health Science and Technology, Aalborg University Hospital, Aalborg, Denmark. 4. Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark. 5. Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. 6. Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. 7. Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
Abstract
BACKGROUND: Recent studies have suggested that vectorcardiographic measures predict left ventricular (LV) reverse remodeling and clinical outcome in patients receiving cardiac resynchronization therapy (CRT). OBJECTIVES: The objectives of this study were to compare predictive abilities of different vectorcardiographic measures (QRS area and sum absolute QRS-T integral) and transformation methods (Kors and inverse Dower) and to assess the independent association between the best predictor and outcomes in CRT recipients. METHODS: This retrospective study included CRT recipients with a digital baseline electrocardiogram, QRS duration ≥120 ms, and ejection fraction ≤35%. The end point was a composite of heart transplantation, LV assist device implantation, or all-cause death. Analyses were performed for the overall cohort and for a prespecified subgroup of patients with left bundle branch block (LBBB). RESULTS: Of 705 included patients with a mean age of 66.6 ± 11.5 years, 492 (70%) were men, 374 (53%) had ischemic heart disease, and 465 (66%) had LBBB. QRS area from vectorcardiograms derived via the Kors transformation demonstrated the best predictive value. In multivariable Cox regression, patients with a smaller QRS area (≤ 95 μVs) had an increased hazard in the overall cohort (adjusted hazard ratio 1.65; 95% CI 1.25-2.18 P < .001) and in the LBBB subgroup (adjusted hazard ratio 1.95; 95% CI 1.38-2.76 P < .001). QRS area was associated with outcome in patients with QRS duration <150 ms (unadjusted hazard ratio 3.85; 95% CI 2.02-7.37 P < .001) and in patients with QRS duration ≥150 ms (unadjusted hazard ratio 1.76; 95% CI 1.32-2.34 P < .001). CONCLUSION: Vectorcardiographic QRS area is associated with survival free from heart transplantation and LV assist device implantation in CRT recipients.
BACKGROUND: Recent studies have suggested that vectorcardiographic measures predict left ventricular (LV) reverse remodeling and clinical outcome in patients receiving cardiac resynchronization therapy (CRT). OBJECTIVES: The objectives of this study were to compare predictive abilities of different vectorcardiographic measures (QRS area and sum absolute QRS-T integral) and transformation methods (Kors and inverse Dower) and to assess the independent association between the best predictor and outcomes in CRT recipients. METHODS: This retrospective study included CRT recipients with a digital baseline electrocardiogram, QRS duration ≥120 ms, and ejection fraction ≤35%. The end point was a composite of heart transplantation, LV assist device implantation, or all-cause death. Analyses were performed for the overall cohort and for a prespecified subgroup of patients with left bundle branch block (LBBB). RESULTS: Of 705 included patients with a mean age of 66.6 ± 11.5 years, 492 (70%) were men, 374 (53%) had ischemic heart disease, and 465 (66%) had LBBB. QRS area from vectorcardiograms derived via the Kors transformation demonstrated the best predictive value. In multivariable Cox regression, patients with a smaller QRS area (≤ 95 μVs) had an increased hazard in the overall cohort (adjusted hazard ratio 1.65; 95% CI 1.25-2.18 P < .001) and in the LBBB subgroup (adjusted hazard ratio 1.95; 95% CI 1.38-2.76 P < .001). QRS area was associated with outcome in patients with QRS duration <150 ms (unadjusted hazard ratio 3.85; 95% CI 2.02-7.37 P < .001) and in patients with QRS duration ≥150 ms (unadjusted hazard ratio 1.76; 95% CI 1.32-2.34 P < .001). CONCLUSION: Vectorcardiographic QRS area is associated with survival free from heart transplantation and LV assist device implantation in CRT recipients.
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