Tomasz Fabiszak1, Piotr Łach2, Jakub Ratajczak2, Marek Koziński3, Wojciech Krupa2, Jacek Kubica2. 1. Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Poland. tfabiszak@cm.umk.pl. 2. Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Poland. 3. Department of Principles of Clinical Medicine, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Poland.
Abstract
BACKGROUND: The aim of the study was to evaluate QRS duration and axis as predictors of response to cardiac resynchronization therapy (CRT) in order to reduce the proportion of non-responders. METHODS: Retrospective single-center study including 42 CRT recipients, with left bundle branch block (LBBB), left ventricular ejection fraction (LVEF) < 40%, in New York Heart Association (NYHA) class ≥ II. Response to CRT was declared as NYHA class improvement ≥ 1 (symptomatic) and LVEF improvement by ≥ 10% (echocardiographic) > 6 months post implantation. RESULTS: Symptomatic responders had longer pre- (172.3 ± 17.9 vs. 159.0 ± 18.3 ms; p = 0.027) and postimplantation (157.2 ± 24.1 vs. 136.7 ± 23.2 ms; p = 0.009) QRS duration. Preimplantation QRS < 150 ms predicted poor response (odds ratio [OR] for response vs. lack of response 0.04; 95% confidence interval [CI] 0.001-0.74). Predictors of symptomatic response included: postimplantation QRS > 160 ms (OR 7.2; 95% CI 1.24-41.94), longer QRS duration before (OR for a 1 ms increase 1.04, 95% CI 1.00-1.08) and post implantation (OR for a 1 ms increase 1.04; 95% CI 1.01-1.07). Area under the curve (AUC) for pre- and postimplantation QRS duration was 0.672 (95% CI 0.51-0.84) and 0.727 (95% CI 0.57-0.89), respectively, with cut-off points of 178.5 ms and 157 ms. For post implantation QRS axis, AUC was 0.689 (95% CI 0.53-0.85), with cut-off points of -60.5° or -38.5°. Preimplantation QRS axis was the only predictor of echocardiographic response (OR 0.98; 95% CI 0.96-1.00), with AUC of 0.693 (95% CI 0.54-0.85) and a threshold of -36°. CONCLUSIONS: Marked pre- and postimplantation QRS prolongation and preimplantation negative QRS axis deviation are moderate predictors of response to CRT.
BACKGROUND: The aim of the study was to evaluate QRS duration and axis as predictors of response to cardiac resynchronization therapy (CRT) in order to reduce the proportion of non-responders. METHODS: Retrospective single-center study including 42 CRT recipients, with left bundle branch block (LBBB), left ventricular ejection fraction (LVEF) < 40%, in New York Heart Association (NYHA) class ≥ II. Response to CRT was declared as NYHA class improvement ≥ 1 (symptomatic) and LVEF improvement by ≥ 10% (echocardiographic) > 6 months post implantation. RESULTS: Symptomatic responders had longer pre- (172.3 ± 17.9 vs. 159.0 ± 18.3 ms; p = 0.027) and postimplantation (157.2 ± 24.1 vs. 136.7 ± 23.2 ms; p = 0.009) QRS duration. Preimplantation QRS < 150 ms predicted poor response (odds ratio [OR] for response vs. lack of response 0.04; 95% confidence interval [CI] 0.001-0.74). Predictors of symptomatic response included: postimplantation QRS > 160 ms (OR 7.2; 95% CI 1.24-41.94), longer QRS duration before (OR for a 1 ms increase 1.04, 95% CI 1.00-1.08) and post implantation (OR for a 1 ms increase 1.04; 95% CI 1.01-1.07). Area under the curve (AUC) for pre- and postimplantation QRS duration was 0.672 (95% CI 0.51-0.84) and 0.727 (95% CI 0.57-0.89), respectively, with cut-off points of 178.5 ms and 157 ms. For post implantation QRS axis, AUC was 0.689 (95% CI 0.53-0.85), with cut-off points of -60.5° or -38.5°. Preimplantation QRS axis was the only predictor of echocardiographic response (OR 0.98; 95% CI 0.96-1.00), with AUC of 0.693 (95% CI 0.54-0.85) and a threshold of -36°. CONCLUSIONS: Marked pre- and postimplantation QRS prolongation and preimplantation negative QRS axis deviation are moderate predictors of response to CRT.
Authors: David H Birnie; Andrew Ha; Lyall Higginson; Kiran Sidhu; Martin Green; François Philippon; Bernard Thibault; George Wells; Anthony Tang Journal: Circ Heart Fail Date: 2013-08-30 Impact factor: 8.790
Authors: Wojciech Zareba; Helmut Klein; Iwona Cygankiewicz; W Jackson Hall; Scott McNitt; Mary Brown; David Cannom; James P Daubert; Michael Eldar; Michael R Gold; Jeffrey J Goldberger; Ilan Goldenberg; Edgar Lichstein; Heinz Pitschner; Mayer Rashtian; Scott Solomon; Sami Viskin; Paul Wang; Arthur J Moss Journal: Circulation Date: 2011-02-28 Impact factor: 29.690
Authors: Andrew Brenyo; Mohan Rao; Alon Barsheshet; David Cannom; Aurelio Quesada; Scott McNitt; David T Huang; Arthur J Moss; Wojciech Zareba Journal: J Cardiovasc Electrophysiol Date: 2012-12-17
Authors: Javier García-Seara; José L Martínez-Sande; Belén Cid; Francisco Gude; María Bastos; Miguel Domínguez; Alfonso Varela; José R González-Juanatey Journal: Rev Esp Cardiol Date: 2008-12 Impact factor: 4.753
Authors: Laura Perrotta; Jagdesh Kandala; Luigi DI Biase; Alessandro Valleggi; Federica Michelotti; Paolo Pieragnoli; Giuseppe Ricciardi; Giosuè Mascioli; Dhanunjaya Lakkireddy; Jayasree Pillarisetti; Michele Emdin; Andrea Natale; Jagmeet P Singh; Luigi Padeletti Journal: J Cardiovasc Electrophysiol Date: 2016-01-14
Authors: Piotr Ponikowski; Adriaan A Voors; Stefan D Anker; Héctor Bueno; John G F Cleland; Andrew J S Coats; Volkmar Falk; José Ramón González-Juanatey; Veli-Pekka Harjola; Ewa A Jankowska; Mariell Jessup; Cecilia Linde; Petros Nihoyannopoulos; John T Parissis; Burkert Pieske; Jillian P Riley; Giuseppe M C Rosano; Luis M Ruilope; Frank Ruschitzka; Frans H Rutten; Peter van der Meer Journal: Eur Heart J Date: 2016-05-20 Impact factor: 29.983
Authors: John G Cleland; William T Abraham; Cecilia Linde; Michael R Gold; James B Young; J Claude Daubert; Lou Sherfesee; George A Wells; Anthony S L Tang Journal: Eur Heart J Date: 2013-07-29 Impact factor: 29.983