Predictive Power of the Baseline QRS Complex Duration for Clinical Response to Cardiac Resynchronisation Therapy

Abstract

Background: Determination of predictors of response to cardiac resynchronisation therapy (CRT) in patients with moderate to severe heart failure accompanied by a ventricular dyssynchrony can play a major role in improving candidate selection for CRT.Objectives: We evaluated whether the baseline QRS duration could be used to discriminate responders from non-responders to CRT.Methods: Eighty-three consecutive patients with moderate to severe heart failure and with successful implantation of a CRT device at our centre were included in the study. QRS durations were measured on 12-lead surface electrocardiogram before and 6 months after implantation of the CRT device, using the widest QRS complex in leads II, V1 and V6. Clinical response to CRT was defined as an improvement of ≥1 grade in NYHA class.Results: Optimal cut-off value to discriminate baseline QRS duration for predicting clinical response to CRT was identified at 152 ms, yielding a sensitivity of 73.3%, a specificity of 56.5% as well as positive and negative predictive values of 81.5% and 44.8%, respectively. The discriminatory power of the baseline QRS duration for response to CRT assessed by the ROC curve was 0.6402 (95% CI: 0.4976 -0.7829). Baseline QRS duration ≥ 152 ms could effectively predict clinical response to CRT after adjusting for covariates (OR = 3.743, p = 0.017).Conclusion: Baseline QRS duration can effectively predict clinical response to CRT and optimal cut-off value to discriminate baseline QRS duration for response to CRT is 152 ms.

The role of the fragmented QRS complexes on a routine 12-lead ECG in predicting non-responsiveness to cardiac resynchronization therapy

“…Different studies have previously focused on mechanical dyssynchrony, interventricular mechanical delay (21) and QRS duration (22) in HF patients candidate for CRT, but few studies have been performed to assess the role of the fQRS complexes in predicting non-responsiveness to CRT. Çelikyurt et al (23) evaluated relationship between fragmented QRS and response to CRT and their findings were very interesting and they suggested further studies to confirm the findings.…”