Native Electrocardiographic QRS Duration after Cardiac Resynchronization Therapy: The Impact on Clinical Outcomes and Prognosis.

Abstract

BACKGROUND:

We investigated whether reversed electrical remodeling (RER), defined as narrowing of the native electrocardiographic QRS duration after cardiac resynchronization therapy (CRT), might predict prognosis and improvement in echocardiographic outcomes.

METHODS AND RESULTS:

A total of 110 CRT recipients were retrospectively analyzed for the end points of death and hospitalization during 18 ± 3 months. Native QRS durations were recorded at baseline and 6 months after CRT (when pacing was switched off to obtain an electrocardiogram) to determine RER. CRT response and mitral regurgitation (MR) improvement were defined as ≥15% reduction in left ventricular end-systolic volume and absolute reduction in regurgitant volume (RegV) at 6 months, respectively. Overall, 48 patients (44%) had RER, which was associated with functional improvement (77% vs 34%; P < .001) and CRT response (81% vs 52%; P < .001) compared with those without RER. The change in the intrinsic QRS duration correlated with the reduction in RegV (r = 0.51; P < .001) and in tenting area (r = 0.34; P < .001). RER was a predictor of MR improvement (P = .023), survival (P = .043), and event-free survival (P = .028) according to multivariate analyses.

CONCLUSIONS:

Narrowing of the intrinsic QRS duration is associated with functional and echocardiographic CRT response, reduction in MR, and favorable prognosis after CRT.

• Authors: Oguz Karaca, Beytullah Cakal, Mehmet Onur Omaygenc, Haci Murat Gunes, Sinem Deniz Cakal, Filiz Kizilirmak, Tayyar Gokdeniz, Irfan Barutcu, Bilal Boztosun, Fethi Kilicaslan
• Journal: Journal of cardiac failure (J Card Fail) Vol. 22 Issue 10 Pg. 772-80 (Oct 2016) ISSN: 1532-8414 [Electronic] United States
• PMID: 27058406 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2016 Elsevier Inc. All rights reserved.

Topics

• Aged
• Analysis of Variance
• Cardiac Resynchronization Therapy (methods, mortality)
• Cause of Death
• Cohort Studies
• Electrocardiography (methods)
• Female
• Heart Failure, Systolic (diagnostic imaging, mortality, therapy)
• Humans
• Kaplan-Meier Estimate
• Logistic Models
• Male
• Middle Aged
• Mitral Valve Insufficiency (diagnostic imaging, mortality, therapy)
• Multivariate Analysis
• Prognosis
• Retrospective Studies
• Risk Assessment
• Severity of Illness Index
• Survival Rate
• Treatment Outcome
• Ventricular Remodeling (physiology)