Differential Response to Cardiac Resynchronization Therapy and Clinical Outcomes According to QRS Morphology and QRS Duration

Dupont, Matthias; Rickard, John; Baranowski, Bryan; Varma, Niraj; Dresing, Thomas; Gabi, Alaa; Finucan, Michael; Mullens, Wilfried; Tang, W.H. Wilson

doi:10.1016/j.jacc.2012.03.059

Cited by 93 publications

(68 citation statements)

References 19 publications

(18 reference statements)

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“…The aforementioned separate analyses showing that QRS duration and morphology are important determinants of clinical benefits of CRT have led to the investigation of the interaction between QRS duration and morphology and its effects on CRT outcomes 5, 10, 23, 24. The sub‐analysis of the RAFT trial (after excluding patients with ventricular pacing and permanent atrial fibrillation) showed that regardless the QRS duration, patients with LBBB morphology who were randomized to CRT with defibrillator function showed a reduction in the rates of the primary outcome (composite endpoint of all‐cause mortality and heart failure hospitalization) (HR 0.640; 95% CI 0.524–0.781; P < 0.001) 5.…”

Section: Discussionmentioning

confidence: 99%

QRS duration versus morphology and survival after cardiac resynchronization therapy

et al. 2016

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AimsThe prognostic implications of QRS duration and morphology in heart failure patients treated with cardiac resynchronization therapy (CRT) remains debated. The present evaluation investigated the association between QRS duration (<150 vs. ≥150 ms) and QRS morphology (left bundle brand block [LBBB] vs. non‐LBBB) and long‐term prognosis of a large cohort of unselected heart failure patients treated with CRT according to contemporary guidelines.Methods and resultsOf 973 heart failure patients treated with CRT (mean age 66.1 ± 9.8 years, 76% male), 658 patients (68%) showed QRS duration ≥150 ms, and 772 patients (79%) had LBBB configuration. Compared with patients with QRS duration <150 ms, patients with QRS duration ≥150 ms had less frequently ischaemic cardiomyopathy and atrial fibrillation and showed larger left ventricular volumes and lower left ventricular ejection fraction. Compared with patients with non‐LBBB configuration, patients with LBBB morphology were younger, less often males and less often had ischaemic cardiomyopathy and atrial fibrillation. On multivariable analysis, after correcting for relevant clinical and echocardiographic variables, LBBB morphology was significantly associated with better survival [hazard ratio (HR) 0.737; 95% confidence interval (CI) 0.584–0.931; P = 0.010], whereas there was no statistically significant association between QRS duration ≥150 ms and survival (HR 0.889; 95% CI 0.726–1.088; P = 0.252).ConclusionsIn this large population of heart failure patients treated with CRT, QRS morphology was independently associated with long‐term survival. The association between QRS duration and long‐term survival was not statistically significant.

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Section: Discussionmentioning

confidence: 99%

QRS duration versus morphology and survival after cardiac resynchronization therapy

et al. 2016

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“…Recent meta-analysis of CRT studies has shown that baseline QRS duration . 150 ms was one of the best predictors of response to CRT (22)(23)(24)(25). Baseline LBBB morphology is associated with significant improvement in HF events, ventricular tachyarrhythmia, and death (23)(24)(25)(26).…”

Section: Comparison With Ecgmentioning

confidence: 98%

“…QRS duration and morphology have been shown to be predictors of response to CRT (22)(23)(24)(25). The Cardiac Resynchronization in Heart Failure study showed mortality benefit with CRT pacing alone in patients with LBBB morphology and QRS duration .…”

Section: Comparison With Ecgmentioning

confidence: 99%

“…The Cardiac Resynchronization in Heart Failure study showed mortality benefit with CRT pacing alone in patients with LBBB morphology and QRS duration . 150 ms (22)(23)(24)(25). Recent meta-analysis of CRT studies has shown that baseline QRS duration .…”

Section: Comparison With Ecgmentioning

confidence: 99%

“…There remains a need for yet more objective and reproducible methods to measure mechanical dyssynchrony. There is a clinical and economic necessity to identify those who will benefit from CRT and the synchrony imaging software is an effort in this direction (24)(25)(26)(27). It would have been desirable to evaluate all the parameters used to assess the functional class of HF patients such as exercise duration and maximum volume of oxygen (VO2 max) consumption (6-min walk), and others, as we characterize the value of new imaging dyssynchrony parameters.…”

Section: Comparison With Ecgmentioning

confidence: 99%

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Utility of Equilibrium Radionuclide Angiogram–Derived Measures of Dyssynchrony to Predict Outcomes in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy

et al. 2016

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We evaluated a novel scintigraphic method using new parameters of mechanical left ventricular (LV) dyssynchrony and correlated it with clinical outcomes in heart failure patients with reduced ejection fraction receiving cardiac resynchronization therapy (CRT). Methods: Sixty-six advanced heart failure patients referred for CRT with an LV ejection fraction (EF) of , 35% and QRS $ 120 ms were studied. We performed equilibrium radionuclide angiography (ERNA) before and 6 mo after CRT. We assessed ventricular dyssynchrony with parameters derived from the first harmonic phase (Ø) analysis of the ERNA time-activity curve and evaluated change in these parameters after 6 mo of CRT. These parameters include novel indices of synchrony (S), a measure of intraventricular contraction order, and entropy (E), a measure of intraventricular contraction disorder, and interventricular synchrony (IVS), a measure of synchronous biventricular function. Results: Forty-seven (71%) patients improved clinically (responders) at 6 mo after CRT whereas 19 (28.8%) showed no change in New York Heart Association class or worsened (nonresponders). The post-CRT changes in QRS duration (P 5 0.006), echocardiographic (P 5 0.03) and ERNA LVEF (P 5 0.0007), LVS (P 5 0.004), LVE (P 5 0.006), LV standard deviation of ventricular phase (LVSDØ) (P 5 0.004), and IVS (P 5 0.05) were significantly different between responders and nonresponders. Sixty-two percent of responders had either an LVS , 0.84 or an IVS $ 18.8°as opposed to only 16% of nonresponders (P 5 0.001). Twenty-nine of 32 (91%) patients with either of these measures responded to CRT (P , 0.01). Conclusion: LVS and IVS are novel measures of LV dyssynchrony derived from ERNA planar analysis. A baseline value of LVS , 0.84 or IVS $ 18.8°predicts a positive response to CRT.

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QRS Duration, Bundle-Branch Block Morphology, and Outcomes Among Older Patients With Heart Failure Receiving Cardiac Resynchronization Therapy

Peterson

Greiner

Qualls

et al. 2013

JAMA

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Differential Response to Cardiac Resynchronization Therapy and Clinical Outcomes According to QRS Morphology and QRS Duration

Abstract: QRS morphology is a more important baseline electrocardiographic determinant of CRT response than QRSd.

Cited by 93 publications

References 19 publications

QRS duration versus morphology and survival after cardiac resynchronization therapy

QRS duration versus morphology and survival after cardiac resynchronization therapy

Utility of Equilibrium Radionuclide Angiogram–Derived Measures of Dyssynchrony to Predict Outcomes in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy

QRS Duration, Bundle-Branch Block Morphology, and Outcomes Among Older Patients With Heart Failure Receiving Cardiac Resynchronization Therapy

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