Cardiogoniometry can predict positive response to cardiac resynchronization therapy – A proof of concept study (original) (raw)
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Vectorcardiographic QRS area as a novel predictor of response to cardiac resynchronization therapy
Journal of Electrocardiology, 2015
Background: QRS duration and left bundle branch block (LBBB) morphology are used to select patients for cardiac resynchronization therapy (CRT). We investigated whether the area of the QRS complex (QRS AREA) on the 3-dimensional vectorcardiogram (VCG) can improve patient selection. Methods: VCG (Frank orthogonal lead system) was recorded prior to CRT device implantation in 81 consecutive patients. VCG parameters, including QRS AREA , were assessed, and compared to QRS duration and morphology. Three LBBB definitions were used, differing in requirement of mid-QRS notching. Responders to CRT (CRT-R) were defined as patients with ≥ 15% reduction in left ventricular end systolic volume after 6 months of CRT. Results: Fifty-seven patients (70%) were CRT-R. QRS AREA was larger in CRT-R than in CRT nonresponders (140 ± 42 vs 100 ± 40 μVs, p b 0.001) and predicted CRT response better than QRS duration (AUC 0.78 vs 0.62, p = 0.030). With a 98 μVs cutoff value, QRS AREA identified CRT-R with an odds ratio (OR) of 10.2 and a 95% confidence interval (CI) of 3.4 to 31.1. This OR was higher than that for QRS duration N 156 ms (OR = 2.5; 95% CI 0.9 to 6.6), conventional LBBB classification (OR = 5.5; 95% CI 0.9 to 32.4) or LBBB classification according to American guidelines (OR = 4.5; 95% CI 1.6 to 12.6) or Strauss (OR = 10.0; 95% CI 3.2 to 31.1). Conclusion: QRS AREA is an objective electrophysiological predictor of CRT response that performs at least as good as the most refined definition of LBBB. Condensed abstract: In 81 candidates for cardiac resynchronization therapy (CRT) we measured the area of the QRS complex (QRS AREA) using 3-dimensional vectorcardiography. QRS AREA was larger in echocardiographic responders than in non-responders and predicted CRT response better than QRS duration and than simple LBBB criteria. QRS AREA is a promising electrophysiological predictor of CRT response.
Europace, 2009
To predict response to cardiac resynchronization therapy (CRT) in patients with heart failure (HF) and intraventricular conduction delay. Methods and results The study population consisted of 82 consecutive HF patients with standard CRT indications. Patients were classified as responders, if they were alive without cardiac decompensation and experienced 15% decrease in left ventricular end-systolic volume. Sixty-eight percent of the enrolled patients responded to CRT. When compared with nonresponders, responders had a wider baseline QRS width (P ¼ 0.001), more marked QRS shortening (DQRS) immediately after CRT (P ¼ 0.001), and a better improvement in aortic velocity time integral (VTI) 24 h after CRT (P ¼ 0.02). Moreover, there was a trend towards a greater baseline intraventricular dyssynchrony in the responder group (P ¼ 0.07). By multivariable logistic regression, the baseline QRS width (OR: 0.95, 95% CI: 0.90-0.97, P ¼ 0.001), DQRS (OR: 1.038, 95% CI: 1.012-1.064, P ¼ 0.003), and acute aortic VTI (OR: 0.81, 95% CI: 0.68-0.96, P ¼ 0.017) emerged as independent predictors of response to CRT. Receiver operating characteristic curve analysis identified a QRS width .145 ms, DQRS .20 ms, and aortic VTI .14 cm to predict responders. Conclusion A positive response to CRT was observed in 68% of the patients. Cardiac resynchronization therapy response is predictable using simple electrocardiographic and echocardiographic data.
QRS Area Is a Strong Determinant of Outcome in Cardiac Resynchronization Therapy
Circulation: Arrhythmia and Electrophysiology, 2018
Background: The combination of left bundle branch block (LBBB) morphology and QRS duration is currently used to select patients for cardiac resynchronization therapy (CRT). These parameters, however, have limitations. This study evaluates the value of QRS area compared with that of QRS duration and morphology in the association with clinical and echocardiographic outcomes in a large cohort of CRT patients. Methods: A retrospective multicentre study was conducted in 1492 CRT patients. LBBB morphology, QRS duration, and QRS area in the baseline 12-lead ECG were evaluated for their association with the occurrence of the combined primary end point of all-cause mortality, cardiac transplantation, and left ventricular assist device implantation. Secondary end points were heart failure hospitalization within the first year after implantation and echocardiographic reduction in left ventricular end-systolic volume. Results: During a mean follow-up period of 3.4 years, 32% of patients reached...
A novel electrocardiographic predictor of clinical response to cardiac resynchronization therapy
Europace, 2013
A wide QRS with left bundle branch block pattern is usually required for cardiac resynchronization therapy (CRT) in patients with dilated cardiomyopathy. However, 30% of patients do not benefit from CRT. We evaluated whether a detailed analysis of QRS complex can improve prediction of CRT success. Methods and results We studied 51 patients (67.3 + 9.5 years, 36 males) with classical indication to CRT. Twelve-lead electrocardiogram (ECG) (50 mm/s, 0.05 mV/mm) was obtained before and 3 months after CRT. The following ECG intervals were measured in leads V1 and V6: (i) total QRS duration; (ii) QRS onset-R wave peak; (iii) R wave peakS wave peak (RS-V1 and RS-V6); (iv) S wave peak-QRS end; and (v) difference between QR in V6 and in V1. Patients were considered as responder when left ventricular ejection fraction (LVEF) increased by ≥5% and New York Heart Association class by ≥1 after 3 months of CRT. Of ECG intervals, only basal RS-V1 was longer in responders (n ¼ 36) compared with non-responders (52.9 + 11.8 vs. 44.0 + 12.6 ms, P ¼ 0.021). Among patients with RS-V1 ≥45 ms 83% responded to CRT vs. 33% of those with RS-V1 , 45 ms (P , 0.001). RS-V1 ≥ 45 ms was independently associated with response to CRT in multivariable analysis (odds ratio 9.8; P ¼ 0.002). A reduction of RS-V1 ≥ 10 ms by CRT also significantly predicted clinical response. RS-V1 shortening correlated with improvement in LVEF (r ¼ 20.45; P , 0.001) and in MS (r ¼ 0.46; P , 0.001). Conclusion Our data point out that RS-V1 interval and its changes with CRT may help to identify patients who are most likely to benefit from CRT.
Circulation, 2011
Background— This study aimed to determine whether QRS morphology identifies patients who benefit from cardiac resynchronization therapy with a defibrillator (CRT-D) and whether it influences the risk of primary and secondary end points in patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial–Cardiac Resynchronization Therapy (MADIT-CRT) trial. Methods and Results— Baseline 12-lead ECGs were evaluated with regard to QRS morphology. Heart failure event or death was the primary end point of the trial. Death, heart failure event, ventricular tachycardia, and ventricular fibrillation were secondary end points. Among 1817 patients with available sinus rhythm ECGs at baseline, there were 1281 (70%) with left bundle-branch block (LBBB), 228 (13%) with right bundle-branch block, and 308 (17%) with nonspecific intraventricular conduction disturbances. The latter 2 groups were defined as non-LBBB groups. Hazard ratios for the primary end point for comparisons of CRT-D...
The Egyptian Journal of Hospital Medicine, 2022
Background: Undoubtedly one of the most successful recent developments in the treatment of heart failure (HF) is cardiac resynchronization therapy (CRT). CRT aims to provide the failing heart with a mechanical advantage that can significantly reduce symptoms and mortality by treating ventricular dyssynchrony, a problem that affects up to onethird of patients with highly symptomatic systolic HF. Objectives: The aim of the current study was to evaluate the effect of different right ventricular (RV) lead positions on QRS complex duration post CRT device implantation in patients indicated for CRT as a treatment of chronic heart failure. Patients and methods: This clinical trial included 100 patients who underwent CRT device implantation as a treatment for heart failure, divided into 2 groups according to the site of RV lead implantation after confirmation of the RV lead position; 54 patients had the RV lead implanted in the RV Apex (RVA n=54) and 46 patients had the RV lead implanted in the RV Septum (RVS n=46). Results: There was no significant difference between the two groups regarding clinical response (NYHA Class) (Pvalue = 0.583), left ventricular ejection fraction (LVEF) (Δ EF 6.26 ± 1.64 in RVS group vs. 6.07 ± 1.43 in RVA group, P-value = 0.575) LVES diameter (47.70 ± 8.03 in RVS group vs. 45.39 ± 7.48 in RVA group, P-value = 0.141) or QRS complex narrowing (Δ QRS 60.93 ± 14.68 in RVS group vs. 54.07 ± 13.12 in RVA group, P-value = 0.182). Conclusion: Our results demonstrate that septal RV pacing in CRT is non-inferior to apical RV pacing regarding the primary objective of the study regarding clinical outcome, narrowing of QRS complex (Δ QRS) or LV reverse remodeling.
Journal of Cardiovascular Translational Research, 2016
Cardiac resynchronization therapy (CRT) is a wellknown treatment modality for patients with a reduced left ventricular ejection fraction accompanied by a ventricular conduction delay. However, a large proportion of patients does not benefit from this therapy. Better patient selection may importantly reduce the number of non-responders. Here, we review the strengths and weaknesses of the electrocardiogram (ECG) markers currently being used in guidelines for patient selection, e.g., QRS duration and morphology. We shed light on the current knowledge on the underlying electrical substrate and the mechanism of action of CRT. Finally, we discuss potentially better ECG-based biomarkers for CRT candidate selection, of which the vectorcardiogram may have high potential. Keywords Electrocardiography. Vectorcardiography. Cardiac mapping. Cardiac resynchronization therapy. Left bundle-branch block Abbreviations LV Left ventricle EF Ejection fraction LBBB Left bundle-branch block CRT Cardiac resynchronization therapy HF Heart failure ECG Electrocardiogram ECGi Electrocardiographic imaging BiV Biventricular Associate Editor Craig Stolen oversaw the review of this article Elien B. Engels and Masih Mafi-Rad contributed equally to this work.