Magnitude of QRS duration reduction after biventricular pacing identifies responders to cardiac resynchronization therapy

Giuseppe Coppola, Gianfranco Ciaramitaro, Giuseppe Stabile, Antonio DOnofrio, Pietro Palmisano, Patrizia Carità, Giosuè Mascioli, Domenico Pecora, Antonio De Simone, Massimiliano Marini, Antonio Rapacciuolo, Gianluca Savarese, Giampiero Maglia, Patrizia Pepi, Luigi Padeletti, Attilio Pierantozzi, Giuseppe Arena, Tiziana Giovannini, Salvatore Ivan Caico, Cinzia NugaraLaura Ajello, Maurizio Malacrida, Egle Corrado

Research output: Contribution to journalArticlepeer-review


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 6 months, 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 6 months 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.

Original languageEnglish
Pages (from-to)450-455
Number of pages6
JournalInternational Journal of Cardiology
Publication statusPublished - Oct 15 2016


  • Cardiac resynchronization therapy
  • ECG
  • Heart failure
  • Pacing
  • Reverse remodeling

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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