2
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Reduction in the QRS area after cardiac resynchronization therapy is associated with survival and echocardiographic response

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Introduction

          Recent studies have shown that the baseline QRS area is associated with the clinical response after cardiac resynchronization therapy (CRT). In this study, we investigated the association of QRS area reduction (∆QRS area) after CRT with the outcome. We hypothesize that a larger ∆QRS area is associated with a better survival and echocardiographic response.

          Methods and Results

          Electrocardiograms (ECG) obtained before and 2–12 months after CRT from 1299 patients in a multi‐center CRT‐registry were analyzed. The QRS area was calculated from vectorcardiograms that were synthesized from 12‐lead ECGs. The primary endpoint was a combination of all‐cause mortality, heart transplantation, and left ventricular (LV) assist device implantation. The secondary endpoint was the echocardiographic response, defined as LV end‐systolic volume reduction ≥ of 15%. Patients with ∆QRS area above the optimal cut‐off value (62 µVs) had a lower risk of reaching the primary endpoint (hazard ratio: 0.43; confidence interval [CI] 0.33–0.56, p < .001), and a higher chance of echocardiographic response (odds ratio [OR] 3.3;CI 2.4–4.6, p < .0001). In multivariable analysis, ∆QRS area was independently associated with both endpoints. In patients with baseline QRS area ≥109 µVs, survival, and echocardiographic response were better when the ∆QRS area was ≥62 µVs ( p < .0001). Logistic regression showed that in patients with baseline QRS area ≥109 µVs, ∆QRS area was the only significant predictor of survival (OR: 0.981; CI: 0.967–0.994, p = .006).

          Conclusion

          ∆QRS area is an independent determinant of CRT response, especially in patients with a large baseline QRS area. Failure to achieve a large QRS area reduction with CRT is associated with a poor clinical outcome.

          Related collections

          Most cited references22

          • Record: found
          • Abstract: not found
          • Article: not found

          2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA).

            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Effect of QRS duration and morphology on cardiac resynchronization therapy outcomes in mild heart failure: results from the Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction (REVERSE) study.

            Cardiac resynchronization therapy (CRT) decreases mortality, improves functional status, and induces reverse left ventricular remodeling in selected populations with heart failure. We aimed to assess the impact of baseline QRS duration and morphology and the change in QRS duration with pacing on CRT outcomes in mild heart failure. Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction (REVERSE) was a multicenter randomized trial of CRT among 610 patients with mild heart failure. Baseline and CRT-paced QRS durations and baseline QRS morphology were evaluated by blinded core laboratories. The mean baseline QRS duration was 151±23 milliseconds, and 60.5% of subjects had left bundle-branch block (LBBB). Patients with LBBB experienced a 25.3-mL/m(2) mean reduction in left ventricular end-systolic volume index (P<0.0001), whereas non-LBBB patients had smaller decreases (6.7 mL/m(2); P=0.18). Baseline QRS duration was also a strong predictor of change in left ventricular end-systolic volume index with monotonic increases as QRS duration prolonged. Similarly, the clinical composite score improved with CRT for LBBB subjects (odds ratio, 0.530; P=0.0034) but not for non-LBBB subjects (odds ratio, 0.724; P=0.21). The association between clinical composite score and QRS duration was highly significant (odds ratio, 0.831 for each 10-millisecond increase in QRS duration; P<0.0001), with improved response at longer QRS durations. The change in QRS duration with CRT pacing was not an independent predictor of any outcomes after correction for baseline variables. REVERSE demonstrated that LBBB and QRS prolongation are markers of reverse remodeling and clinical benefit with CRT in mild heart failure. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00271154.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Reconstruction of the Frank vectorcardiogram from standard electrocardiographic leads: diagnostic comparison of different methods.

              Three methods for reconstructing the Frank VCG from the standard 12-lead ECG were studied. The first was based on multivariate regression, the second on a model of the cardio-electrical activity, and the third method used a quasi-orthogonal set of ECG leads. The methods were evaluated on a test set of 90 cases by a numerical distance measure and by the agreement in diagnostic classification of the original and reconstructed VCGs. The original and reconstructed VCGs were presented separately and in random order to three referees. Eighteen of the original VCGs were presented three times to estimate the intra-observer agreement. Kappa statistics were used to quantify the agreement between diagnostic classifications. Separately, one referee was simultaneously presented the original VCG and its three reconstructions for all cases. Each reconstruction VCG was classified as either diagnostically 'same' as the original, 'borderline' or 'different'. The performance of the regression method and the model-based method was comparable. Both methods were preferable to the quasi-orthogonal method. The kappa values for the preferred methods indicated a good to excellent diagnostic agreement between the original and reconstructed VCGs. Only one out of ninety VCGs that were reconstructed with the regression method was classified as 'different' compared with the original VCGs; three VCGs were classified as 'different' with the model-based method. It was also found that estimation of similarity by a distance measure could not replace diagnostic evaluation by skilled observers.
                Bookmark

                Author and article information

                Contributors
                mohammed.ghossein@mumc.nl
                Journal
                J Cardiovasc Electrophysiol
                J Cardiovasc Electrophysiol
                10.1111/(ISSN)1540-8167
                JCE
                Journal of Cardiovascular Electrophysiology
                John Wiley and Sons Inc. (Hoboken )
                1045-3873
                1540-8167
                28 January 2021
                March 2021
                : 32
                : 3 ( doiID: 10.1111/jce.v32.3 )
                : 813-822
                Affiliations
                [ 1 ] Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM) Maastricht University Maastricht The Netherlands
                [ 2 ] Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM) Maastricht University Medical Centre+ Maastricht The Netherlands
                [ 3 ] Department of Medical Signals Institute of Scientific Instruments of the Czech Academy of Sciences Brno Czech Republic
                [ 4 ] Department of Cardiology, University of Groningen University Medical Center Groningen Groningen The Netherlands
                [ 5 ] Department of Cardiology University Medical Center Utrecht Utrecht The Netherlands
                [ 6 ] Department of Cardiology Radboud University Medical Centre Nijmegen The Netherlands
                Author notes
                [*] [* ] Correspondence 

                Mohammed A. Ghossein, MD, Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands.

                Email: mohammed.ghossein@ 123456mumc.nl

                Author information
                https://orcid.org/0000-0003-2359-8167
                https://orcid.org/0000-0002-7936-360X
                https://orcid.org/0000-0001-8917-9032
                Article
                JCE14910
                10.1111/jce.14910
                7986123
                33476467
                e101f90a-a5f4-4917-bf9b-9a906cb1be75
                © 2021 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 05 January 2021
                : 09 September 2020
                : 14 January 2021
                Page count
                Figures: 4, Tables: 4, Pages: 10, Words: 5515
                Categories
                Original Articles
                Original Articles
                Implantable Device Therapy
                Custom metadata
                2.0
                March 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.0 mode:remove_FC converted:23.03.2021

                Cardiovascular Medicine
                cardiac resynchronization therapy,echocardiographic response,heart failure,qrs area,qrs area reduction,survival

                Comments

                Comment on this article