A novel electrocardiographic predictor of clinical response to cardiac resynchronization therapy.

Roberto Mollo, Alessandro Cosenza, Ilaria Coviello, Alessandra Stazi, Giulio Russo, Angelo Villano, Alfonso Sestito, Gianluigi Bencardino, Gaetano A. Lanza, Filippo Crea

Research output: Contribution to journalArticle

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Abstract

A wide QRS with left bundle branch block pattern is usually required for cardiac resynchronization therapy (CRT) in patients with dilated cardiomyopathy. However, ∼30% of patients do not benefit from CRT. We evaluated whether a detailed analysis of QRS complex can improve prediction of CRT success. We studied 51 patients (67.3 + 9.5 years, 36 males) with classical indication to CRT. Twelve-lead electrocardiogram (ECG) (50 mm/s, 0.05 mV/mm) was obtained before and 3 months after CRT. The following ECG intervals were measured in leads V1 and V6: (i) total QRS duration; (ii) QRS onset-R wave peak; (iii) R wave peak-S wave peak (RS-V1 and RS-V6); (iv) S wave peak-QRS end; and (v) difference between QR in V6 and in V1. Patients were considered as responder when left ventricular ejection fraction (LVEF) increased by ≥5% and New York Heart Association class by ≥1 after 3 months of CRT. Of ECG intervals, only basal RS-V1 was longer in responders (n = 36) compared with non-responders (52.9 ± 11.8 vs. 44.0 ± 12.6 ms, P = 0.021). Among patients with RS-V1 ≥45 ms 83% responded to CRT vs. 33% of those with RS-V1 <45 ms (P <0.001). RS-V1 ≥ 45 ms was independently associated with response to CRT in multivariable analysis (odds ratio 9.8; P = 0.002). A reduction of RS-V1 ≥ 10 ms by CRT also significantly predicted clinical response. RS-V1 shortening correlated with improvement in LVEF (r = -0.45; P <0.001) and in MS (r = 0.46; P <0.001). Our data point out that RS-V1 interval and its changes with CRT may help to identify patients who are most likely to benefit from CRT.

Original languageEnglish
Pages (from-to)1615-1621
Number of pages7
JournalEuropace
Volume15
Issue number11
Publication statusPublished - Nov 2013

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Cardiac Resynchronization Therapy
Electrocardiography
Stroke Volume
Bundle-Branch Block
Dilated Cardiomyopathy
Odds Ratio

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Mollo, R., Cosenza, A., Coviello, I., Stazi, A., Russo, G., Villano, A., ... Crea, F. (2013). A novel electrocardiographic predictor of clinical response to cardiac resynchronization therapy. Europace, 15(11), 1615-1621.

A novel electrocardiographic predictor of clinical response to cardiac resynchronization therapy. / Mollo, Roberto; Cosenza, Alessandro; Coviello, Ilaria; Stazi, Alessandra; Russo, Giulio; Villano, Angelo; Sestito, Alfonso; Bencardino, Gianluigi; Lanza, Gaetano A.; Crea, Filippo.

In: Europace, Vol. 15, No. 11, 11.2013, p. 1615-1621.

Research output: Contribution to journalArticle

Mollo, R, Cosenza, A, Coviello, I, Stazi, A, Russo, G, Villano, A, Sestito, A, Bencardino, G, Lanza, GA & Crea, F 2013, 'A novel electrocardiographic predictor of clinical response to cardiac resynchronization therapy.', Europace, vol. 15, no. 11, pp. 1615-1621.
Mollo R, Cosenza A, Coviello I, Stazi A, Russo G, Villano A et al. A novel electrocardiographic predictor of clinical response to cardiac resynchronization therapy. Europace. 2013 Nov;15(11):1615-1621.
Mollo, Roberto ; Cosenza, Alessandro ; Coviello, Ilaria ; Stazi, Alessandra ; Russo, Giulio ; Villano, Angelo ; Sestito, Alfonso ; Bencardino, Gianluigi ; Lanza, Gaetano A. ; Crea, Filippo. / A novel electrocardiographic predictor of clinical response to cardiac resynchronization therapy. In: Europace. 2013 ; Vol. 15, No. 11. pp. 1615-1621.
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abstract = "A wide QRS with left bundle branch block pattern is usually required for cardiac resynchronization therapy (CRT) in patients with dilated cardiomyopathy. However, ∼30{\%} of patients do not benefit from CRT. We evaluated whether a detailed analysis of QRS complex can improve prediction of CRT success. We studied 51 patients (67.3 + 9.5 years, 36 males) with classical indication to CRT. Twelve-lead electrocardiogram (ECG) (50 mm/s, 0.05 mV/mm) was obtained before and 3 months after CRT. The following ECG intervals were measured in leads V1 and V6: (i) total QRS duration; (ii) QRS onset-R wave peak; (iii) R wave peak-S wave peak (RS-V1 and RS-V6); (iv) S wave peak-QRS end; and (v) difference between QR in V6 and in V1. Patients were considered as responder when left ventricular ejection fraction (LVEF) increased by ≥5{\%} and New York Heart Association class by ≥1 after 3 months of CRT. Of ECG intervals, only basal RS-V1 was longer in responders (n = 36) compared with non-responders (52.9 ± 11.8 vs. 44.0 ± 12.6 ms, P = 0.021). Among patients with RS-V1 ≥45 ms 83{\%} responded to CRT vs. 33{\%} of those with RS-V1 <45 ms (P <0.001). RS-V1 ≥ 45 ms was independently associated with response to CRT in multivariable analysis (odds ratio 9.8; P = 0.002). A reduction of RS-V1 ≥ 10 ms by CRT also significantly predicted clinical response. RS-V1 shortening correlated with improvement in LVEF (r = -0.45; P <0.001) and in MS (r = 0.46; P <0.001). Our data point out that RS-V1 interval and its changes with CRT may help to identify patients who are most likely to benefit from CRT.",
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