Quantification of abnormal QRS peaks predicts response to cardiac resynchronization therapy and tracks structural remodeling

Suszko, Adrian; Nayyar, Sachin; Porta‐Sánchez, Andreu; Das, Moloy; Pintér, Arnold; Crystal, Eugene; Tomlinson, George; Dalvi, Rupin; Chauhan, Vijay S.

doi:10.1371/journal.pone.0217875

Cited by 4 publications

(4 citation statements)

References 23 publications

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“…Patients having QRS complexes > 150 ms and echocardiographic indications of mechanical dyssynchrony after 6 months who had implantation of Cardiac Resynchronization Therapy show a large decrease in LV diameter (LVEDD, LVESD) and a significant improvement in MPI [8][9][10]. There is a failure rate of over 30% with CRT.…”

Section: Discussionmentioning

confidence: 99%

Frequency of Left Ventricular Mechanical Dyssynchrony in Chronic Heart Failure

Khan¹,

Khan²,

Ahmad³

et al. 2023

PJMHS

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Objective: To determine the frequency of left ventricular mechanical dyssynchrony in chronic heart failure patients. Material and Methods: After approval from the Hospital ethical committee, the study was conducted in the department of cardiology Hayatabad medical complex Peshawar from 1st September 2021 to 28th February 2022. In this descriptive cross-sectional study, 155 patients in total were examined while 27% of heart failure patients had mechanical dyssynchrony, a 95% confidence interval, and a 7% margin of error were maintained according to WHO sample size computations. Results: This study's participants had an average age of 60, with a standard deviation of ±1.26 years. 62% of the patients were male, compared to 38% of females. 35% of patients had a Broad QRS complex, whereas 65% of patients had a Narrow QRS complex. Mechanical dyssynchrony was identified in 32% of chronic heart failure patients. Conclusion: Patients in chronic heart failure with QRS > 150ms and having mechanical dyssynchrony are benefited with Cardiac Ressynchronisation Therapy (CRT) implantation which reduces morbidity and mortality, while those with a narrow QRS (<150ms) are generally non – responders. Keywords: Mechanical dyssynchrony, chronic heart failure, left ventricular ejection fraction

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Section: Discussionmentioning

confidence: 99%

Frequency of Left Ventricular Mechanical Dyssynchrony in Chronic Heart Failure

Khan¹,

Khan²,

Ahmad³

et al. 2023

PJMHS

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“…Major morphological changes in native QRS or complete resolution of LBBB after CRT are rarely observed and occurred only in few cases in the included studies [13,26]. Although, minor morphological changes may occur, as described by Suszko et al [23]. They assessed the number of leads with fragmented QRS before CRT and during followup with high resolution ECG and found that that reduction of leads with fragmented QRS was strongly associated with mechanical response.…”

Section: Mechanism Of Reverse Electrical Remodelingmentioning

confidence: 91%

“…In addition, we compared extent of iQRS duration change in patients with mechanical response versus without mechanical response. Data were extracted from six studies with 356 participants, of whom 231 (64.9%) were defined as mechanical responders [14,19,[21][22][23][24]. We found that while mechanical responders had a mean of iQRS shortening of 7.7 ms, mechanical non-responders experienced widening of iQRS by mean of 5.2 ms (Supplementary Fig.…”

Section: Association Between Electrical and Mechanical Responsementioning

confidence: 99%

Association between electrical and mechanical remodeling after cardiac resynchronization therapy: systematic review and meta-analysis of observational studies

et al. 2022

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Cardiac resynchronization therapy (CRT) may improve not only impaired left ventricular contractility but can also induce reverse remodeling of native conduction system. Measurement of intrinsic QRS complex width during follow-up is the simplest method to assess reverse electrical remodeling (RER). We aimed to provide a literature review and meta-analysis on incidence and impact of RER and its association with mechanical remodeling. A systematic review and random-effect meta-analysis of studies reporting data on RER was performed. A total of 16 studies were included in this meta-analysis with 930 patients undergoing CRT (mean age 64.0 years, 64.1% males). The weighted mean incidence of RER was 42%. Reverse mechanical remodeling assessed by echocardiography was more frequently observed in patients with RER compared to patients without RER (75.7% vs. 46.6%; odds ratio [OR] 3.7, 95% confidence interval [CI] 2.24-6.09, p < 0.01). Mechanical responders had a mean iQRS shortening of 7.7 ms, while mechanical non-responders experienced a mean widening of iQRS by 5.2 ms (p < 0.01). Clinical improvement was more frequent in patients with RER vs. patients without RER (82.9% vs. 49.0%; OR 5.26; 95% CI 2.92-9.48; p < 0.01). No significant difference in all-cause mortality between patients with and without RER was found. Mean difference between baseline intrinsic QRS and post-implantation paced QRS was significant in patients with later RER (21.2 ms, 95% CI 9.4-32.9, p < 0.01), but not in patients without RER (6.6 ms, 95% CI -2.2-15.4, p = 0.14). Gender, initial left bundle block morphology and heart failure etiology were found not to be predictive for RER. Our meta-analysis demonstrates that shortening of iQRS duration is a common finding during follow-up of patients undergoing CRT and is associated with mechanical reverse remodeling and clinical improvement. Clinical Trial Registration: Prospero Database-CRD42021253336.

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“…The evaluation of electrical dyssynchrony using QRS duration (QRSd) was more reliable to predict CRT outcome [4]. Nonetheless, in patients with QRSd < 150 ms, there are limited data on markers of electrical dyssynchrony [5]. Hence, recognition of patients who are likely to benefit from CRT before the device implantation is still challenging.…”

Section: Introductionmentioning

confidence: 99%

Circulating metabolite profiles to predict response to cardiac resynchronization therapy

Gong

Sun

Huang

et al. 2020

BMC Cardiovasc Disord

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Background: Heart failure is associated with ventricular dyssynchrony and energetic inefficiency, which can be alleviated by cardiac resynchronization therapy (CRT) with approximately one-third of non-response rate. Thus far, there is no specific biomarker to predict the response to CRT in patients with heart failure. In this study, we assessed the role of the blood metabolomic profile in predicting the response to CRT. Methods: A total of 105 dilated cardiomyopathy patients with severe heart failure who received CRT were included in our two-stage study. Baseline blood samples were collected prior to CRT implantation. The response to CRT was defined according to echocardiographic criteria. Metabolomic profiling of serum samples was carried out using ultrahigh performance liquid chromatography coupled with quadrupole-time-of-flight mass spectrometry. Results: Seventeen metabolites showed significant differences in their levels between responders and nonresponders, and these metabolites were primarily involved in six pathways, including linoleic acid metabolism, Valine, leucine and isoleucine biosynthesis, phenylalanine metabolism, citrate cycle, tryptophan metabolism, and sphingolipid metabolism. A combination of isoleucine, tryptophan, and linoleic acid was identified as an ideal metabolite panel to distinguish responders from non-responders in the discovery set (n = 51 with an AUC of 0.981), and it was confirmed in the validation set (n = 54 with an AUC of 0.929). Conclusions: Mass spectrometry based serum metabolomics approach provided larger coverage of metabolome which can help distinguish CRT responders from non-responders. A combination of isoleucine, tryptophan, and linoleic acid may associate with significant prognostic values for CRT.

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Quantification of abnormal QRS peaks predicts response to cardiac resynchronization therapy and tracks structural remodeling

Cited by 4 publications

References 23 publications

Frequency of Left Ventricular Mechanical Dyssynchrony in Chronic Heart Failure

Frequency of Left Ventricular Mechanical Dyssynchrony in Chronic Heart Failure

Association between electrical and mechanical remodeling after cardiac resynchronization therapy: systematic review and meta-analysis of observational studies

Circulating metabolite profiles to predict response to cardiac resynchronization therapy

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