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Reduction in the QRS area after cardiac resynchronization therapy is associated with survival and echocardiographic response
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SYSNO ASEP 0559945 Document Type J - Journal Article R&D Document Type Journal Article Subsidiary J Článek ve WOS Title Reduction in the QRS area after cardiac resynchronization therapy is associated with survival and echocardiographic response Author(s) Ghossein, M. A. (NL)
van Stipdonk, A. M. W. (NL)
Plešinger, Filip (UPT-D) RID, ORCID, SAI
Kloosterman, M. (NL)
Wouters, P. C. (NL)
Salden, O. A. E. (NL)
Meine, M. (NL)
Maass, A. H. (NL)
Prinzen, F. W. (NL)
Vernooy, K. (NL)Number of authors 10 Source Title Journal of Cardiovascular Electrophysiology. - : Wiley - ISSN 1045-3873
Roč. 32, č. 3 (2021), s. 813-822Number of pages 10 s. Publication form Print - P Language eng - English Country US - United States Keywords cardiac resynchronization therapy ; echocardiographic response ; heart failure ; QRS area ; QRS area reduction ; survival Subject RIV FA - Cardiovascular Diseases incl. Cardiotharic Surgery OECD category Cardiac and Cardiovascular systems Method of publishing Open access Institutional support UPT-D - RVO:68081731 UT WOS 000612475500001 EID SCOPUS 85099840874 DOI 10.1111/jce.14910 Annotation 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.Workplace Institute of Scientific Instruments Contact Martina Šillerová, sillerova@ISIBrno.Cz, Tel.: 541 514 178 Year of Publishing 2023 Electronic address https://onlinelibrary.wiley.com/doi/10.1111/jce.14910
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