open access

Vol 27, No 5 (2020)
Original articles — Clinical cardiology
Published online: 2018-11-14
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Influence of QRS duration and axis on response to cardiac resynchronization therapy in chronic heart failure with reduced left ventricular ejection fraction: A single center study including patients with left bundle branch block

Tomasz Fabiszak, Piotr Łach, Jakub Ratajczak, Marek Koziński, Wojciech Krupa, Jacek Kubica
DOI: 10.5603/CJ.a2018.0138
·
Pubmed: 30444259
·
Cardiol J 2020;27(5):575-582.

open access

Vol 27, No 5 (2020)
Original articles — Clinical cardiology
Published online: 2018-11-14

Abstract

Background: The aim of the study was to evaluate QRS duration and axis as predictors of response to cardiac resynchronization therapy (CRT) in order to reduce the proportion of non-responders.

Methods:
Retrospective single-center study including 42 CRT recipients, with left bundle branch block (LBBB), left ventricular ejection fraction (LVEF) < 40%, in New York Heart Association (NYHA) class ≥ II. Response to CRT was declared as NYHA class improvement ≥ 1 (symptomatic) and LVEF improvement by ≥ 10% (echocardiographic) > 6 months post implantation.

Results:
Symptomatic responders had longer pre- (172.3 ± 17.9 vs. 159.0 ± 18.3 ms; p = 0.027) and postimplantation (157.2 ± 24.1 vs. 136.7 ± 23.2 ms; p = 0.009) QRS duration. Preimplantation QRS < 150 ms predicted poor response (odds ratio [OR] for response vs. lack of response 0.04; 95% confidence interval [CI] 0.001–0.74). Predictors of symptomatic response included: postimplantation QRS > 160 ms (OR 7.2; 95% CI 1.24–41.94), longer QRS duration before (OR for a 1 ms increase 1.04, 95% CI 1.00–1.08) and post implantation (OR for a 1 ms increase 1.04; 95% CI 1.01–1.07). Area under the curve (AUC) for pre- and postimplantation QRS duration was 0.672 (95% CI 0.51–0.84) and 0.727 (95% CI 0.57–0.89), respectively, with cut-off points of 178.5 ms and 157 ms. For post implantation QRS axis, AUC was 0.689 (95% CI 0.53–0.85), with cut-off points of –60.5° or –38.5°. Preimplantation QRS axis was the only predictor of echocardiographic response (OR 0.98; 95% CI 0.96–1.00), with AUC of 0.693 (95% CI 0.54–0.85) and a threshold of –36°.

Conclusions:
Marked pre- and postimplantation QRS prolongation and preimplantation negative QRS axis deviation are moderate predictors of response to CRT.

Abstract

Background: The aim of the study was to evaluate QRS duration and axis as predictors of response to cardiac resynchronization therapy (CRT) in order to reduce the proportion of non-responders.

Methods:
Retrospective single-center study including 42 CRT recipients, with left bundle branch block (LBBB), left ventricular ejection fraction (LVEF) < 40%, in New York Heart Association (NYHA) class ≥ II. Response to CRT was declared as NYHA class improvement ≥ 1 (symptomatic) and LVEF improvement by ≥ 10% (echocardiographic) > 6 months post implantation.

Results:
Symptomatic responders had longer pre- (172.3 ± 17.9 vs. 159.0 ± 18.3 ms; p = 0.027) and postimplantation (157.2 ± 24.1 vs. 136.7 ± 23.2 ms; p = 0.009) QRS duration. Preimplantation QRS < 150 ms predicted poor response (odds ratio [OR] for response vs. lack of response 0.04; 95% confidence interval [CI] 0.001–0.74). Predictors of symptomatic response included: postimplantation QRS > 160 ms (OR 7.2; 95% CI 1.24–41.94), longer QRS duration before (OR for a 1 ms increase 1.04, 95% CI 1.00–1.08) and post implantation (OR for a 1 ms increase 1.04; 95% CI 1.01–1.07). Area under the curve (AUC) for pre- and postimplantation QRS duration was 0.672 (95% CI 0.51–0.84) and 0.727 (95% CI 0.57–0.89), respectively, with cut-off points of 178.5 ms and 157 ms. For post implantation QRS axis, AUC was 0.689 (95% CI 0.53–0.85), with cut-off points of –60.5° or –38.5°. Preimplantation QRS axis was the only predictor of echocardiographic response (OR 0.98; 95% CI 0.96–1.00), with AUC of 0.693 (95% CI 0.54–0.85) and a threshold of –36°.

Conclusions:
Marked pre- and postimplantation QRS prolongation and preimplantation negative QRS axis deviation are moderate predictors of response to CRT.

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Keywords

cardiac resynchronization therapy, heart failure, left bundle branch block, QRS axis

About this article
Title

Influence of QRS duration and axis on response to cardiac resynchronization therapy in chronic heart failure with reduced left ventricular ejection fraction: A single center study including patients with left bundle branch block

Journal

Cardiology Journal

Issue

Vol 27, No 5 (2020)

Pages

575-582

Published online

2018-11-14

DOI

10.5603/CJ.a2018.0138

Pubmed

30444259

Bibliographic record

Cardiol J 2020;27(5):575-582.

Keywords

cardiac resynchronization therapy
heart failure
left bundle branch block
QRS axis

Authors

Tomasz Fabiszak
Piotr Łach
Jakub Ratajczak
Marek Koziński
Wojciech Krupa
Jacek Kubica

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