Predictors and Outcomes of “Super-response” to Cardiac Resynchronization Therapy

Killu, Ammar M.; Grupper, Avishay; Friedman, Paul A.; Powell, Brian D.; Asirvatham, Samuel J.; Espinosa, Raúl E.; Luria, David; Rozen, Guy; Buber, Jonathan; Lee, Ying‐Hsiang; Webster, Tracy L.; Brooke, Kelly L.; Hodge, David O.; Wiste, Heather J.; Glikson, Michael; Mei, Yong

doi:10.1016/j.cardfail.2014.03.001

Cited by 40 publications

(29 citation statements)

References 33 publications

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“…9,10,21) This finding is also practical in clinical situations because a 12-lead ECG is available for every patient before CRT and provides a reasonable sensitivity and specificity in predicting the response to CRT. Although some other tools are also available for predicting outcome after CRT, such as echocardiography including the tissue Doppler technique, 22) cardiovascular magnetic resonance, 23,24) and nomograms, 3,22,25,26) QRS duration and complete LBBB on a surface ECG are still the proven independent predictors for the response after CRT. 3,27) In the present study, the shortest, longest, and average QRS durations were significantly different.…”

Section: Discussionmentioning

confidence: 99%

The Shortest QRS Duration of an Electrocardiogram Might Be an Optimal Electrocardiographic Predictor for Response to Cardiac Resynchronization Therapy

2017

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SummaryQRS duration has been associated with the response to cardiac resynchronization therapy (CRT). However, the methods for defining QRS duration to predict the outcome of CRT have discrepancies in previous reports. The aim of this study was to determine an optimal measurement of QRS duration to predict the response to CRT.Sixty-one patients who received CRT were analyzed. All patients had class III-IV heart failure, left ventricular ejection fraction not more than 35%, and complete left bundle branch block. The shortest, longest, and average QRS durations from the 12 leads of each electrocardiogram (ECG) were measured. The responses to CRT were determined using the changes in echocardiography after 6 months. Thirty-five (57.4%) patients were responders and 26 (42.6%) patients were non-responders. The pre-procedure shortest, average, and longest QRS durations and the QRS shortening (ΔQRS) of the shortest QRS duration were significantly associated with the response to CRT in a univariate logistic regression analysis (P = 0.002, P = 0.03, P = 0.04 and P = 0.04, respectively). Based on the measurement of the area under curve of the receiver operating characteristic curve, only the pre-procedure shortest QRS duration and the ΔQRS of the shortest QRS duration showed significant discrimination for the response to CRT (P = 0.002 and P = 0.038, respectively). Multivariable logistic regression showed the pre-procedure shortest QRS duration is an independent predictor for the response to CRT.The shortest QRS duration from the 12 leads of the electrocardiogram might be an optimal measurement to predict the response to CRT. (Int Heart J 2017; 58: 530-535) Key words: Heart failure C ardiac resynchronization therapy (CRT) is a wellknown procedure for improving left ventricular function via reverse remodeling in patients with heart failure.1) The QRS durations before implantation and at follow-up may predict the patient's response to CRT, especially in the presence of left bundle branch block (LBBB).2-8) However, the QRS durations are usually different and diverse among the 12-lead electrocardiogram (ECG). 9) Additionally, in previous reports, the methods to define the QRS duration in predicting a CRT patient's outcome have discrepancies and lack standardization of QRS duration measurement.10) Many different methods for QRS duration measurement have been used in previous studies, including the QRS duration of one selected lead, 11,12) the longest QRS duration, 13) the average QRS duration of 12 leads, 14) and undefined. 6,15,16) International guidelines for heart failure management also have not recommended a preferred standard measurement technique for QRS duration for CRT.2,10,17,18) Lack of standard measurement in the QRS duration might have a significant influence on the conclusions of different studies.10) Thus, this is the crucial reason why the recommended QRS duration for CRT implantation was different and variable in previous reports. However, the decision-making for suggesting that a patient receive a CRT implanta...

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Section: Discussionmentioning

confidence: 99%

The Shortest QRS Duration of an Electrocardiogram Might Be an Optimal Electrocardiographic Predictor for Response to Cardiac Resynchronization Therapy

2017

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“…2) El hecho de no haber analizado el comportamiento de la terapia farmacológica en el tiempo, las condiciones socioeconómicas, la calidad de vida, el antecedente de infarto de miocardio en los 40 días previos al implante, el efecto de la revascularización cardíaca y los patrones de programación de los dispositivos electrofisiológicos versus la supervivencia. Son necesarios en nuestro medio estudios multicén-tricos que permitan conclusiones con mayor validez externa e identifiquen el comportamiento de los marcadores de respuesta a la terapia de resincronización cardíaca (48).…”

Section: Discussionunclassified

Terapia de resincronización cardíaca con o sin cardiodesfibrilador versus terapia con desfibrilador automático, Pereira (Colombia): un estudio de cohorte

Franco

Cárdenas-Castellanos

Rivera-Toquica

et al. 2016

iatreia

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RESUMENObjetivo: comparar la supervivencia de pacientes con resincronizador cardíaco con o sin desfibrilador con la de pacientes con cardiodesfibrilador.Materiales y métodos: cohorte retrospectiva cuyo desenlace primario fue la mortalidad de origen cardíaco; la exposición fueron las terapias electrofisiológicas y la información se obtuvo de las historias clínicas y de otros registros médicos.Resultados: se estudiaron 70 pacientes de edad avanzada con dispositivos funcionales. El 82 % recibieron tratamiento farmacológico optimizado. No se encontró asociación significativa entre la probabilidad de supervivencia y la terapia de resincronización cardíaca con o sin cardiodesfibrilador versus la terapia con cardiodesfibrilador (log rank test p = 0,54), pero sí un mayor tiempo de supervivencia en los primeros (ANOVA p = 0,0012). La tasa de peligro fue 0,017 para el día 371 y del 0,15 para el día 2169. Durante el período de observación se presentaron 14 muertes, tres de ellas atribuibles a etiología no cardíaca.Conclusión: se observó que la terapia con resincronizador cardíaco se asoció de forma significativa con un mayor tiempo supervivencia.

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“…Впервые данные о суперответе были опубликованы в 2005 г. в двух исследованиях: в работе Bulawa А с соавт., которые описали клинический случай -72-летнего паци-ента с полным восстановлением размеров и функции ЛЖ через 1 год после имплантации СРТ, и в исследовании Blank JJ с соавт., которыми была описана группа пациен-тов с неишемической КМП и блокадой левой ножки пуч-ка Гиса (БЛНПГ) с нормализацией ФВ ЛЖ более 50 % на фоне СРТ [15,16]. В более поздних работах авторы также использовали динамику ФВ ЛЖ, как критерий «суперответа», однако целевой уровень ФВ ЛЖ менял-ся от исследования к исследованию [17][18][19]. До сих пор нет единого мнения о том, какого критерия следует при-держиваться при определении понятия «суперреспон-дер» [20][21][22][23].…”

Section: Discussionunclassified

“…В литературе были описаны разные факторы, ассо-циированные с «суперответом», например, длитель-ность заболевания, неишемический генез КМП, ширина комплекса QRS, наличие БЛНПГ [5,17,18,20,22,29]. По всем перечисленным показателям в нашем исследо-вании значимых отличий выявлено не было.…”

Section: Discussionunclassified

A “superresponse” to cardiac resynchronization therapy in patients with chronic heart failure

Kuznetsov¹,

Melnikov²,

Krinochkin³

et al. 2015

RHFJ

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Predictors and Outcomes of “Super-response” to Cardiac Resynchronization Therapy

Cited by 40 publications

References 33 publications

The Shortest QRS Duration of an Electrocardiogram Might Be an Optimal Electrocardiographic Predictor for Response to Cardiac Resynchronization Therapy

The Shortest QRS Duration of an Electrocardiogram Might Be an Optimal Electrocardiographic Predictor for Response to Cardiac Resynchronization Therapy

Terapia de resincronización cardíaca con o sin cardiodesfibrilador versus terapia con desfibrilador automático, Pereira (Colombia): un estudio de cohorte

A “superresponse” to cardiac resynchronization therapy in patients with chronic heart failure

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