Changes in QRS Duration Are Associated with a Therapeutic Response to Sacubitril–valsartan in Heart Failure with Reduced Ejection Fraction

Abstract

BACKGROUND: Recent studies have demonstrated that angiotensin receptor neprilysin inhibitors (ARNIs) can reverse the cardiac remodeling effects that occur in heart failure with reduced ejection fraction (HFrEF). These studies have also suggested that ARNIs have favorable effects on ventricular dyssynchrony. We assessed the changes in QRS duration associated with ARNIs in patients with HFrEF. METHODS: We retrospectively investigated patients with HFrEF (defined by a left ventricular ejection fraction [LVEF] ≤ 35%) who were treated with ARNIs for at least six months. We divided the patients into QRS shortening and non-QRS shortening groups according to their electrocardiogram (ECG) findings. We also compared changes in echocardiographic parameters between the groups. RESULTS: A total of 68 patients with HFrEF were included (mean age: 62.5 years, 74.6% male). Twenty-one patients had significant ischemic heart disease (IHD). Thirty-five patients exhibited QRS-duration shortening on follow-up ECGs (mean change: −7.8 msec), and 33 patients showed no changes or increased QRS duration (mean change: 5.1 msec). The QRS shortening group exhibited significant improvement in LVEF (12.5 ± 15.3% vs. 1.7 ± 9.5%; p < 0.001) when compared with the non-QRS shortening group. The QRS shortening group also had significantly lower LV end-diastolic dimension (LVEDD), LV end-systolic dimension (LVESD) and LV mass index (LVMI) than did the non-QRS shortening group. The change in QRS duration was significantly correlated with the change in LVEF (r =-0.329, p = 0.011) and LVESD (r = 0.298, p = 0.022). CONCLUSIONS: Among patients with HFrEF treated with ARNIs, the QRS shortening group showed favorable LV systolic function recovery, and reversal of cardiac remodeling compared to those of the non-QRS shortening group. Change in the QRS duration, which reflects LV synchrony, may be associated with response to ARNIs in patients with HFrEF.

Determining whether LV filling time contributes to HF symptoms in different widths of QRS in LBBB patients: a clinical study

“…Our findings suggest that QRS duration is negatively correlated with LVEF in patients with LBBB. QRS duration also appears to be a reflection of LV ejection fraction, in line with the study by Kim and colleagues 16 . A study of 23 patients with normal conduction and 12 patients with complete LBBB reported that patients with complete LBBB had higher end-systolic and diastolic volumes and a lower EF than patients with normal conduction 17 .…”

Duration of Heart Failure With Reduced Ejection Fraction Associated With Electrocardiographic Outcomes Before and After Sacubitril/Valsartan

“…18 Shorter QRS durations, which reflect favorable cardiac reverse remodeling processes and LV synchrony, may be associated with responses to ARNIs in patients with HFrEF, compared with non-QRS shortening. 19 Besides, greater LVEF is achieved with earlier initiation of GDMT in patients with HF duration <1 year, compared with those with !1 year. 8 In our study, we also found different alterations in the electrophysiological parameters after sacubitril/valsartan therapy.…”

Impact of baseline ECG characteristics on changes in cardiac biomarkers and echocardiographic metrices after acute myocardial infarction treated with Empagliflozin

“…Larger left ventricular volumes were also found to be associated with QRS width as well as Q-waves after anterior MI and was inversely associated with LVEF 37 . The potential for better LV-recovery in HFrEF treated with ARNIs was described to be better in patients with shorter QRS complex 38 . Our analysis did not identify any significant associations of LV-volumes and LV-diameters with baseline QRS width.…”