Effect of lateral wall scar on reverse remodeling with cardiac resynchronization therapy

Birnie, David H.; deKemp, Rob; Ruddy, T; Tang, Antony; Guo, Ann; Williams, Kathryn; Wassenar, Richard; Lalonde, Michel; Beanlands, Rob

doi:10.1016/j.hrthm.2009.08.014

Cited by 30 publications

(31 citation statements)

References 26 publications

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“…In the Medicare Registry of 14 946 patients undergoing CRT, there were 2952 (20%) patients with NIVCD. 10 These patients had intermediate outcomes compared with patients with RBBB and LBBB. For example, the HR for mortality at 1 year compared with patients with LBBB was 1.18 (1.05-1.32).…”

Section: Discussionmentioning

confidence: 95%

“…5,6 Potential explanations for this include insufficient left ventricular (LV) mechanical dyssynchrony 7,8 and excess LV scaring. 9,10 Previous studies have shown that a left bundle-branch block (LBBB) pattern is a strong predictor of outcomes compared with the presence of other ECG morphologies. [11][12][13][14][15][16][17][18][19] Several other key clinical questions remain, and more data are required to inform these issues.…”

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confidence: 99%

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Impact of QRS Morphology and Duration on Outcomes After Cardiac Resynchronization Therapy

Birnie

Higginson

et al. 2013

Circ: Heart Failure

133

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Background-The impact of QRS morphology and duration on the effectiveness of cardiac resynchronization therapy (CRT) has been usually assessed separately. The interaction between these 2 simple ECG parameters and their effect on CRT has not been systematically assessed in a large-scale clinical trial. Methods and Results-The Resynchronization-Defibrillation for Ambulatory Heart Failure Trial showed that implantable cardioverter defibrillator-CRT was associated with a significant reduction in the primary end point of all-cause mortality or heart failure hospitalization. For this substudy, we excluded patients in atrial fibrillation and those with a previous pacemaker. All baseline ECGs were reviewed by a panel of 3 experienced electrocardiographers. A total of 1483 patients were included in this study. Of these, 1175 had left bundle-branch block (LBBB) and 308 had non-LBBB. In patients with LBBB receiving implantable cardioverter defibrillator-CRT, there was a reduction in the primary outcome and in each individual component of the primary outcome. Furthermore, there was continuous relationship between QRS duration and extent of benefit. In patients with non-LBBB and QRS ≥160 ms, the hazard ratio for the primary outcome was 0.52 (0.29-0.96; P=0.033); in patients with QRS <160 ms, the hazard ratio was 1.38 (0.88-2.14; P=0.155). Conclusions-In patients with LBBB, there was a continuous relationship between broader QRS and greater benefit from implantable cardioverter defibrillator-CRT. However, our data do not support the use of implantable cardioverter defibrillator-CRT in patients with non-LBBB, especially when the QRS duration is <160 ms. There may be some delayed benefit when the QRS is ≥160 ms, but this needs further investigation. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00251251.

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Section: Discussionmentioning

confidence: 95%

mentioning

confidence: 99%

Impact of QRS Morphology and Duration on Outcomes After Cardiac Resynchronization Therapy

Birnie

Higginson

et al. 2013

Circ: Heart Failure

133

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“…25,26 Also, scar at the site of pacing and total scar burden decrease the response to CRT because dead tissue is less likely to contract, even with pacing. [25][26][27][28][29] In PROSPECT-ECG, nonis- Table 3). None of the ECG parameters that predicted an improvement in LVESV interacted with cardiomyopathy cause, suggesting the ECG parameters are applicable to both ( Table 4).…”

Section: Discussionmentioning

confidence: 99%

Paced Left Ventricular QRS Width and ECG Parameters Predict Outcomes After Cardiac Resynchronization Therapy

Hsing

Selzman

Leclercq

et al. 2011

Circ: Arrhythmia and Electrophysiology

114

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Background-For patients with symptomatic New York Heart Association class III or IV, ejection fraction Յ35%, and QRS Ն130 ms, cardiac resynchronization therapy (CRT) has become an established treatment option. However, use of these implant criteria fails to result in clinical or echocardiographic improvement in 30% to 45% of CRT patients. Methods and Results-The Predictors of Response to CRT (PROSPECT)-ECG is a substudy of the prospective observational PROSPECT trial. ECGs collected before, during, and after CRT implantation were analyzed. Primary outcomes were improvement in clinical composite score (CCS) and reduction of left ventricular end systolic volume (LVESV) of Ͼ15% after 6 months. Age, sex, cause of cardiomyopathy, myocardial infarction location, right ventricular function, mitral regurgitation, preimplantation QRS width, preimplantation PR interval, preimplantation right ventricular-paced QRS width, preimplantation axis categories, LV-paced QRS width, postimplantation axis categories, difference between biventricular (Bi-V) pacing and preimplantation QRS width, and QRS bundle branch morphological features were analyzed univariably in logistic regression models to predict outcomes. All significant predictors (␣ϭ0.1), age, and sex were used for multivariable analyses. Cardiomyopathy cause interaction and subanalyses were also performed.

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“…11,12 Our group and others have observed that the extent of regional or LV scaring also seems important in determining response to CRT. [13][14][15][16] Left bundle branch block (LBBB) leads to regions of both early and delayed contraction [17][18][19] which results in reduced work in early activated regions (i.e., the septum) and increased work in late-activated regions (i.e., the LV free wall). 18 Reduced septal work in patients with LBBB is associated with decreased glucose utilization as measured using positron emission tomography (PET) imaging.…”

Section: Introductionmentioning

confidence: 99%

Reduced septal glucose metabolism predicts response to cardiac resynchronization therapy

Birnie

Kemp

Tang

et al. 2012

Journal of Nuclear Cardiology

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Effect of lateral wall scar on reverse remodeling with cardiac resynchronization therapy

Cited by 30 publications

References 26 publications

Impact of QRS Morphology and Duration on Outcomes After Cardiac Resynchronization Therapy

Impact of QRS Morphology and Duration on Outcomes After Cardiac Resynchronization Therapy

Paced Left Ventricular QRS Width and ECG Parameters Predict Outcomes After Cardiac Resynchronization Therapy

Reduced septal glucose metabolism predicts response to cardiac resynchronization therapy

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