Alwin Zweerink1, Daniel J Friedman2, Igor Klem2, Peter M van de Ven3, Caitlin Vink1, P Stefan Biesbroek1, Steen M Hansen2,4, Kasper Emerek2,5, Raymond J Kim2, Albert C van Rossum1, Brett D Atwater2, Robin Nijveldt1,6, Cornelis P Allaart1. 1. Department of Cardiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, the Netherlands (ACS) (A.Z., C.V., S.B., A.C.v.R., R.N., C.P.A.). 2. Division of Cardiology, Duke University Hospital, Durham, NC (D.J.F., I.K., S.M.H., K.E., R.J.K., B.D.A.). 3. Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands (P.M.v.d.V.). 4. Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Denmark (S.M.H.). 5. Department of Clinical Medicine, Aalborg University Hospital, Denmark (K.E.). 6. Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (R.N.).
Abstract
BACKGROUND: In patients with left bundle branch block (LBBB), QRS duration (QRSd) depends on left ventricular (LV) dimension. Previously, we demonstrated that normalizing QRSd to LV dimension, to adjust for variations in LV size, improved prediction of hemodynamic response to cardiac resynchronization therapy (CRT). In addition, sex-specific differences in CRT outcome have been attributed to normalized QRSd. The present study evaluates the effect of normalization of QRSd to LV dimension on prediction of survival after CRT implantation. METHODS: In this 2-center study, we studied 250 heart failure patients with LV ejection fraction ≤35% and QRSd ≥120 ms who underwent cardiac magnetic resonance imaging before CRT implantation. LV end-diastolic volumes were used for QRSd normalization (ie, QRSd/LV end-diastolic volumes). The primary end point was a combined end point of death, LV assist device, or heart transplantation. RESULTS: During a median follow-up of 3.9 years, 79 (32%) patients reached the primary end point. Using univariable Cox regression, unadjusted QRSd was unrelated to CRT outcome ( P=0.116). In contrast, normalized QRSd was a strong predictor of survival (hazard ratio, 0.81 per 0.1 ms/mL; P=0.008). Women demonstrated higher normalized QRSd than men (0.62±0.17 versus 0.55±0.17 ms/mL; P=0.003) and showed better survival after CRT (hazard ratio, 0.52; P=0.018). A multivariable prognostic model included normalized QRSd together with age, atrial fibrillation, renal function, and heart failure cause, whereas sex, diabetes mellitus, strict left bundle branch block morphology, and LV end-diastolic volumes were expelled from the model. CONCLUSIONS: Normalization of QRSd to LV dimension improves prediction of survival after CRT implantation. In addition, sex-specific differences in CRT outcome might be attributed to the higher QRSd/LV end-diastolic volumes ratio that was found in selected women, indicating more conduction delay.
BACKGROUND: In patients with left bundle branch block (LBBB), QRS duration (QRSd) depends on left ventricular (LV) dimension. Previously, we demonstrated that normalizing QRSd to LV dimension, to adjust for variations in LV size, improved prediction of hemodynamic response to cardiac resynchronization therapy (CRT). In addition, sex-specific differences in CRT outcome have been attributed to normalized QRSd. The present study evaluates the effect of normalization of QRSd to LV dimension on prediction of survival after CRT implantation. METHODS: In this 2-center study, we studied 250 heart failurepatients with LV ejection fraction ≤35% and QRSd ≥120 ms who underwent cardiac magnetic resonance imaging before CRT implantation. LV end-diastolic volumes were used for QRSd normalization (ie, QRSd/LV end-diastolic volumes). The primary end point was a combined end point of death, LV assist device, or heart transplantation. RESULTS: During a median follow-up of 3.9 years, 79 (32%) patients reached the primary end point. Using univariable Cox regression, unadjusted QRSd was unrelated to CRT outcome ( P=0.116). In contrast, normalized QRSd was a strong predictor of survival (hazard ratio, 0.81 per 0.1 ms/mL; P=0.008). Women demonstrated higher normalized QRSd than men (0.62±0.17 versus 0.55±0.17 ms/mL; P=0.003) and showed better survival after CRT (hazard ratio, 0.52; P=0.018). A multivariable prognostic model included normalized QRSd together with age, atrial fibrillation, renal function, and heart failure cause, whereas sex, diabetes mellitus, strict left bundle branch block morphology, and LV end-diastolic volumes were expelled from the model. CONCLUSIONS: Normalization of QRSd to LV dimension improves prediction of survival after CRT implantation. In addition, sex-specific differences in CRT outcome might be attributed to the higher QRSd/LV end-diastolic volumes ratio that was found in selected women, indicating more conduction delay.
Authors: Hye Bin Gwag; June Soo Kim; Kyoung-Min Park; Young Keun On; Seung-Jung Park Journal: J Interv Card Electrophysiol Date: 2021-03-27 Impact factor: 1.900
Authors: Albert K Feeny; John Rickard; Kevin M Trulock; Divyang Patel; Saleem Toro; Laurie Ann Moennich; Niraj Varma; Mark J Niebauer; Eiran Z Gorodeski; Richard A Grimm; John Barnard; Anant Madabhushi; Mina K Chung Journal: Circ Arrhythm Electrophysiol Date: 2020-06-14
Authors: John Rickard; Divyang Patel; Carolyn Park; Joseph E Marine; Sunil Sinha; W H Wilson Tang; Niraj Varma; Bruce L Wilkoff; David Spragg Journal: JACC Clin Electrophysiol Date: 2020-10-28
Authors: Josef Halamek; Pavel Leinveber; Ivo Viscor; Radovan Smisek; Filip Plesinger; Vlastimil Vondra; Jolana Lipoldova; Magdalena Matejkova; Pavel Jurak Journal: PLoS One Date: 2019-05-31 Impact factor: 3.240
Authors: Marthe A J Becker; Cornelis P Allaart; Alwin Zweerink; Jan H Cornel; Peter M van de Ven; Albert C van Rossum; Tjeerd Germans Journal: Int J Cardiol Heart Vasc Date: 2020-01-25
Authors: Fatema Said; Jozine M Ter Maaten; Pieter Martens; Kevin Vernooy; Mathias Meine; Cornelis P Allaart; Bastiaan Geelhoed; Marc A Vos; Maarten J Cramer; Isabelle C van Gelder; Wilfried Mullens; Michiel Rienstra; Alexander H Maass Journal: J Clin Med Date: 2021-11-25 Impact factor: 4.241
Authors: Daniel J Friedman; Kasper Emerek; Peter L Sørensen; Emily P Zeitler; Sarah A Goldstein; Sana M Al-Khatib; Peter Søgaard; Claus Graff; Brett D Atwater Journal: Heart Rhythm O2 Date: 2020-08-04