TY - JOUR
T1 - Magnitude of QRS duration reduction after biventricular pacing identifies responders to cardiac resynchronization therapy
AU - Coppola, Giuseppe
AU - Ciaramitaro, Gianfranco
AU - Stabile, Giuseppe
AU - DOnofrio, Antonio
AU - Palmisano, Pietro
AU - Carità, Patrizia
AU - Mascioli, Giosuè
AU - Pecora, Domenico
AU - De Simone, Antonio
AU - Marini, Massimiliano
AU - Rapacciuolo, Antonio
AU - Savarese, Gianluca
AU - Maglia, Giampiero
AU - Pepi, Patrizia
AU - Padeletti, Luigi
AU - Pierantozzi, Attilio
AU - Arena, Giuseppe
AU - Giovannini, Tiziana
AU - Caico, Salvatore Ivan
AU - Nugara, Cinzia
AU - Ajello, Laura
AU - Malacrida, Maurizio
AU - Corrado, Egle
PY - 2016/10/15
Y1 - 2016/10/15
N2 - 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.
AB - 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.
KW - Cardiac resynchronization therapy
KW - ECG
KW - Heart failure
KW - Pacing
KW - Reverse remodeling
UR - http://www.scopus.com/inward/record.url?scp=84978164285&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84978164285&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2016.06.203
DO - 10.1016/j.ijcard.2016.06.203
M3 - Article
AN - SCOPUS:84978164285
VL - 221
SP - 450
EP - 455
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
ER -