open access

Vol 15, No 4 (2008)
Original articles
Published online: 2008-05-21
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Relationship between QRS complex notch and ventricular dyssynchrony in patients with heart failure and prolonged QRS duration

Amir Farjam Fazelifar, Hamid Reza Bonakdar, Keivan Alizadeh, Hosein Azarnik, Majid Haghjoo, Hooman Bakhshandeh Abkenar, Niloufar Samiei, Mohammad Ali Sadr-Ameli
Cardiol J 2008;15(4):351-356.

open access

Vol 15, No 4 (2008)
Original articles
Published online: 2008-05-21

Abstract

Background: Cardiac resynchronization therapy (CRT) has been accepted as an established therapy for advanced systolic heart failure. Electrical and mechanical dyssynchrony are usually evaluated to increase the percentage of CRT responders. We postulated that QRS notch can increase mechanical LV dyssynchrony independently of other known predictors such as left ventricular ejection fraction and QRS duration.
Methods: A total of 87 consecutive patients with advanced systolic heart failure and QRS duration more than 120 ms with an LBBB-like pattern in V1 were prospectively evaluated. Twelve-lead electrocardiogram was used for detection of QRS notch. Complete echocardiographic examination including tissue Doppler imaging, pulse wave Doppler and M-mode echocardiography were done for all patients.
Results: Eighty-seven patients, 65 male (75%) and 22 female (25%), with mean (SD) age of 56.7 (12.3) years were enrolled the study. Ischemic cardiomyopathy was the underlying heart disease in 58% of the subjects, and in the others it was idiopathic. Patients had a mean (SD) QRS duration of 155.13 (23.34) ms. QRS notch was seen in 49.4% of the patients in any of two precordial or limb leads. Interventricular mechanical delay was the only mechanical dyssynchrony index that was significantly longer in the group of patients with QRS notch. Multivariate analysis revealed that the observed association was actually caused by the effect of QRS duration, rather than the presence of notch per se.
Conclusions: QRS notch was not an independent predictor of higher mechanical dyssynchrony indices in patients with wide QRS complex and symptomatic systolic heart failure; however, there was a borderline association between QRS notch and interventricular delay.

Abstract

Background: Cardiac resynchronization therapy (CRT) has been accepted as an established therapy for advanced systolic heart failure. Electrical and mechanical dyssynchrony are usually evaluated to increase the percentage of CRT responders. We postulated that QRS notch can increase mechanical LV dyssynchrony independently of other known predictors such as left ventricular ejection fraction and QRS duration.
Methods: A total of 87 consecutive patients with advanced systolic heart failure and QRS duration more than 120 ms with an LBBB-like pattern in V1 were prospectively evaluated. Twelve-lead electrocardiogram was used for detection of QRS notch. Complete echocardiographic examination including tissue Doppler imaging, pulse wave Doppler and M-mode echocardiography were done for all patients.
Results: Eighty-seven patients, 65 male (75%) and 22 female (25%), with mean (SD) age of 56.7 (12.3) years were enrolled the study. Ischemic cardiomyopathy was the underlying heart disease in 58% of the subjects, and in the others it was idiopathic. Patients had a mean (SD) QRS duration of 155.13 (23.34) ms. QRS notch was seen in 49.4% of the patients in any of two precordial or limb leads. Interventricular mechanical delay was the only mechanical dyssynchrony index that was significantly longer in the group of patients with QRS notch. Multivariate analysis revealed that the observed association was actually caused by the effect of QRS duration, rather than the presence of notch per se.
Conclusions: QRS notch was not an independent predictor of higher mechanical dyssynchrony indices in patients with wide QRS complex and symptomatic systolic heart failure; however, there was a borderline association between QRS notch and interventricular delay.
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Keywords

QRS notch; mechanical dyssynchrony; cardiac resynchronization therapy; tissue Doppler echocardiography

About this article
Title

Relationship between QRS complex notch and ventricular dyssynchrony in patients with heart failure and prolonged QRS duration

Journal

Cardiology Journal

Issue

Vol 15, No 4 (2008)

Pages

351-356

Published online

2008-05-21

Bibliographic record

Cardiol J 2008;15(4):351-356.

Keywords

QRS notch
mechanical dyssynchrony
cardiac resynchronization therapy
tissue Doppler echocardiography

Authors

Amir Farjam Fazelifar
Hamid Reza Bonakdar
Keivan Alizadeh
Hosein Azarnik
Majid Haghjoo
Hooman Bakhshandeh Abkenar
Niloufar Samiei
Mohammad Ali Sadr-Ameli

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