Effect of QRS Duration and Morphology on Cardiac Resynchronization Therapy Outcomes in Mild Heart Failure

Gold, Michael R.; Thébault, Christophe; Linde, Cecilia; Abraham, William T.; Gerritse, Bart; Ghio, Stefano; Sutton, Martin St. John; Daubert, Jean Claude

doi:10.1161/circulationaha.112.097709

Cited by 282 publications

(104 citation statements)

References 33 publications

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“…24 LBBB is clearly more evident in early LVRR patients. 25,26 In our study, Groups B and C had a higher incidence of ischemic etiology. Several previous studies have shown less clinical and LV function improvement in ischemic patients, probably due to the presence of myocardial scar tissue in the vicinity of the pacing lead, limiting the extent of LVRR regardless of the extent of baseline dyssynchrony.…”

Section: Discussionsupporting

confidence: 45%

Time to left ventricular reverse remodeling after cardiac resynchronization therapy: Better late than never

Monteiro

Oliveira

Cunha

et al. 2016

Revista Portuguesa de Cardiologia

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Introduction: Left ventricular reverse remodeling (LVRR), defined as reduction of end-diastolic and end-systolic dimensions and improvement of ejection fraction, is associated with the prognostic implications of cardiac resynchronization therapy (CRT). The time course of LVRR remains poorly characterized. Nevertheless, it has been suggested that it occurs ≤6 months after CRT. Objective: To characterize the long-term echocardiographic and clinical evolution of patients with LVRR occurring >6 months after CRT and to identify predictors of a delayed LVRR response. Methods: A total of 127 consecutive patients after successful CRT implantation were divided into three groups according to LVRR response: Group A, 19 patients (15%) with LVRR after >6 months (late LVRR); Group B, 58 patients (46%) with LVRR before 6 months (early LVRR); and Group C, 50 patients (39%) without LVRR during follow-up (no LVRR). Results: The late LVRR group was older, more often had ischemic etiology and fewer patients were in NYHA class ≤II. Overall, group A presented LVRR between group B and C. This was also the case with the percentage of clinical response (68.4% vs. 94.8% vs. 38.3%, respectively, p<0.001), and hospital readmissions due to decompensated heart failure (31.6% vs. 12.1% vs. 57.1%, respectively, p<0.001). Ischemic etiology (OR 0.044; p=0.013) and NYHA functional class 6 meses após TRC, e identificar preditores de uma resposta de RIVE tardia. Métodos: Cento e vinte e sete P consecutivos, após implantação bem-sucedida de TRC, foram divididos em três grupos, de acordo com a resposta de RIVE: grupo A, 19P (15%) com RIVE após seis meses (RIVE tardia); grupo B, 58P (46%) com RIVE antes dos seis meses (RIVE precoce) e grupo C, 50P (39%) sem RIVE durante o follow-up (sem RIVE). Resultados: O grupo da RIVE tardia era mais velho, tinha mais etiologia isquémica e menos P em classe NYHA≥III. Globalmente, o grupo A apresentou um gr...

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Section: Discussionsupporting

confidence: 45%

Time to left ventricular reverse remodeling after cardiac resynchronization therapy: Better late than never

Monteiro

Oliveira

Cunha

et al. 2016

Revista Portuguesa de Cardiologia

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“…7 The REVERSE study confirmed the importance of QRS duration and LBBB pattern in CRT outcomes. 26 With regard to our study, the sample size, the higher percentage of patients with nonischemic etiology and mean QRS >150 ms influenced our results.…”

Section: Discussionmentioning

confidence: 79%

Predictors of response to cardiac resynchronization therapy: A prospective cohort study

Abreu

Oliveira

Cunha

et al. 2017

Revista Portuguesa de Cardiologia (English Edition)

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Introduction: Cardiac resynchronization therapy (CRT) has modified the prognosis of chronic heart failure (HF) with left ventricular systolic dysfunction. However, 30% of patients do not have a favorable response. The big question is how to determine predictors of response. Aims: To identify baseline characteristics that might influence echocardiographic response to CRT. Methods and Results:We performed a prospective single-center hospital-based cohort study of consecutive HF patients selected to CRT (NYHA class II-IV, left ventricular ejection fraction (LVEF) <35% and QRS complex ≥120 ms). Responders were defined as those with a ≥5% absolute increase in LVEF at six months. Clinical, electrocardiographic, laboratory, echocardiographic, autonomic, endothelial and cardiopulmonary function parameters were assessed before CRT device implantation. Logistic regression models were used. Seventy-nine patients were included, 54 male (68.4%), age 68.1 years (standard deviation 10.2), 19 with ischemic etiology (24%).At six months, 51 patients (64.6%) were considered responders. Although by univariate analysis baseline tricuspid annular plane systolic excursion (TAPSE) and serum creatinine were significantly different in responders, on multivariate analysis only TAPSE was independently associated with response, with higher values predicting a positive response to CRT (OR=1.13; 95% CI: 1.02-1.26; p=0.020). TAPSE ≥15 mm was strongly associated with response, and TAPSE <15 mm with non-response (p=0.005). Responders had no TAPSE values below 10 mm. * Corresponding author. E-mail address: ananabreu@hotmail.com (A. Abreu). 2174-2049Document downloaded from http://www.elsevier.es, day 21/07/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. Document downloaded from http://www.elsevier.es, day 21/07/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. 418 A. Abreu et al. Conclusion: From a range of clinical and technical baseline characteristics, Metodologia e resultados:Estudo cohort prospetivo, unicêntrico, hospitalar, de doentes consecutivos com HF selecionados para CRT (classes II-IV NYHA, fração de ejeção ventricular esquerda <35% e QRS≥120 mseg).Os respondedores foram definidos por aumento absoluto de fração de ejeção ventricular esquerda ≥5% aos 6 meses.Antes da implantação do ressincronizador, foram avaliados parâmetros clínicos, eletrocardiográficos, laboratoriais, ecocardiográficos, autonómicos, endoteliais e funcionais cardiorrespiratórios. Utilizaram-se modelos de regressão logística.Incluíram-se 79 doentes, 54 masculinos (68,4%), idade 68,1 (SD=10,2) anos, 19 isquémicos (24%). Aos 6 meses, consideraram-se respondedores 51 doentes (64,6%). Apesar de, por análise univariável, a excursão sistólica do plano do anel tricúspide (TAPSE) e a creatinina sérica serem significativamente diferentes nos respondedores, em análise multivariável, apenas TAPSE foi independentemente associada a res...

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“…Although the parameters based on the echo cardiography had been most anticipated, PROSPECT trial13 which was performed aiming to determine echo parameters to predict responders and nonresponders of CRT failed to find any parameters. On the other hand, subanalysis of major trials including COMPANION,4 MADIT‐CRT,14 or REVERSE15 revealed that the patients with QRS width ≥150 ms were likely to receive most benefit of CRT and LBBB pattern seemed to have better outcome than right bundle branch block or nonspecific block pattern. QRS width ≥150 ms was also an important predictor for responders in RAFT trial 12.…”

Section: Can We Predict the Effect Of Crt?mentioning

confidence: 99%

Up‐to‐date cardiac resynchronization therapy

Okamura

2017

J of Gen and Family Med

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Cardiac resynchronization therapy (CRT) has been first reported more than 10 years ago as a therapy for patients with severe chronic heart failure. The efficacy of CRT has been proven in many studies that it improves not only quality of life but also the prognosis of the patients. Its indication has been expanded for patients with mild heart failure. On the other hand, some patients cannot receive enough benefit through CRT. The position of the left ventricular lead is limited due to the anatomy of coronary sinus branches, pacing threshold of the myocardium, phrenic nerve stimulation, and so on. Also, the right selection of the candidates for CRT is critical to receive the most benefit of this therapy. The target of this review article is to describe the efficacy and the indication of CRT, which can be of any help to enroll more patients with heart failure who are likely to get benefits through CRT.

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Effect of QRS Duration and Morphology on Cardiac Resynchronization Therapy Outcomes in Mild Heart Failure

Cited by 282 publications

References 33 publications

Time to left ventricular reverse remodeling after cardiac resynchronization therapy: Better late than never

Time to left ventricular reverse remodeling after cardiac resynchronization therapy: Better late than never

Predictors of response to cardiac resynchronization therapy: A prospective cohort study

Up‐to‐date cardiac resynchronization therapy

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