Effect of QRS Narrowing After Cardiac Resynchronization Therapy on Functional Mitral Regurgitation in Patients With Systolic Heart Failure

Karaca, Oğuz; Omaygenç, Mehmet Onur; Çakal, Beytullah; Çakal, Sinem; Güneş, Hacı Murat; Barutçu, İrfan; Boztosun, Bilal; Kılıçaslan, Fethi

doi:10.1016/j.amjcard.2015.11.010

Cited by 19 publications

(13 citation statements)

References 25 publications

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“…A reduction in QRS duration after CRT has been shown to acutely improve hemodynamics and as well as left ventricular reverse remodeling . In addition, narrowing of the QRS has been associated with a reduction in functional mitral regurgitation as well as a reduction in cardiovascular hospitalizations and mortality . Our findings of a negative moderate correlation between change in QRS duration and change in LVEF further support the significance of QRS narrowing after CRT.…”

Section: Discussionsupporting

confidence: 72%

Predicting response to cardiac resynchronization therapy: Use of strict left bundle branch block criteria

Hadjis

AlTurki

Proietti

et al. 2019

Pacing Clinical Electrophis

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Background Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in heart failure with reduced ejection fraction (HFrEF). CRT efficacy is greater in left bundle branch block (LBBB). This study aimed to determine if strict LBBB criteria predict an improved QRS duration and left ventricular ejection fraction (LVEF) response after CRT. Methods HFrEF patients who received a CRT device at a single quaternary center were included. Patients were divided into three groups based on baseline QRS morphology. Group 1 consisted of patients with strict LBBB. Group 2 had conventional LBBB, and group 3 had non‐LBBB morphology. Outcomes assessed included change in QRS duration after CRT, change in LVEF, and all‐cause mortality. Results In 231 patients, 56% of patients were in group 1, 29% were in group 2, and 15% were in group 3. Patients with strict LBBB had a significant reduction in QRS duration (–20.9 ± 12.4 ms) compared to conventional LBBB (6.7 ± 19.4 ms; P < 0.0001) and non‐LBBB (3.9 ± 29.3 ms; P < 0.0001). Patients with strict LBBB had a significant increase in LVEF (19.5 ± 10.2) compared to conventional LBBB (5.3 ± 12.6; P < 0.0001) and non‐LBBB (–1.3 ± 10.9; P < 0.0001). There was moderate negative correlation between changes in QRS duration and LVEF (correlation coefficient = –0.63, P < 0.0001). Strict LBBB criteria were associated with a significant reduction in mortality compared to conventional LBBB (odds ratio 0.49, 95% confidence interval 0.24 to 0.99; P = 0.046). Conclusions Strict LBBB predicted a reduction in QRS duration and an increase in LVEF compared to conventional LBBB and non‐LBBB morphology in patients with HFrEF who received CRT.

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Section: Discussionsupporting

confidence: 72%

Predicting response to cardiac resynchronization therapy: Use of strict left bundle branch block criteria

Hadjis

AlTurki

Proietti

et al. 2019

Pacing Clinical Electrophis

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“…Previous reports showed that the proportion of HF patients with a narrowing QRS duration on 12‐lead ECGs after CRT implantation was approximately 60%, including both ischemic and nonischemic etiologies (Molhoek et al., ; Rickard et al., ; Karaca et al., ). In our study, 59 (57%) nonischemic HF patients showed a narrowing QRS duration on 12‐lead ECGs after CRT implantation and 53 (51%) showed narrowing fQRS on SAECGs.…”

Section: Discussionmentioning

confidence: 99%

“…Reverse LV remodeling by CRT, which is assessed as a response by echocardiography, predicts clinical outcomes, including symptoms, exercise tolerance, and death or HF events, and reduces disease progression. Previous reports have suggested that narrowing QRS duration after CRT implantation is associated with enhanced reverse LV remodeling (responder to CRT) (Molhoek et al., ; Lecoq et al., ; Rickard et al.,, ; Karaca et al., ). The predictors of response to the CRT (PROSPECT)‐ECG trial suggested that the difference between the biventricular pace and preimplantation QRS duration can predict improvement of the clinical composite score (Hsing et al., ).…”

Section: Introductionmentioning

confidence: 97%

Narrowing filtered QRS duration on signal‐averaged electrocardiogram predicts outcomes in cardiac resynchronization therapy patients with nonischemic heart failure

Suzuki

Shiga

Daigo

et al. 2017

Noninvasive Electrocardiol

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“…Shortened paced QRSd and greater ∆QRSd, especially ∆QRSd ≥20 ms, reflect greater functional mitral regurgitation improvement, higher CRT response rate, and lower rates of death and hospitalization. 13 In the present study, only ∆QRSd was chosen because it had a close association with paced QRSd (Pearson correlation, r=0.63, P<0.001), and because ∆QRSd had higher accuracy than paced QRSd (76% vs. 73%) on logistic multivariate regression analysis. ERR+MRR improved LV remodeling and led to a more favorable mitral geometry.…”

Section: Shortened Paced Qrsd (∆Qrsd) Can Predict Err+mrrmentioning

confidence: 99%

“…The difference between the baseline widest and the paced widest QRS duration was defined as ∆QRSd (baseline intrinsic QRSd−paced QRSd). 13 The measurement of QTc interval in atrial fibrillation was obtained from the average of 3 consecutive beats, as in the previous study. 14 All ECG were recorded at 25 mm/s with an amplification of 10 mm/mV.…”

Section: Ecg Parametersmentioning

confidence: 99%

Prediction of Both Electrical and Mechanical Reverse Remodeling on Acute Electrocardiogram Changes After Cardiac Resynchronization Therapy

Cheng¹,

Chou³

et al. 2017

Circ J

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as decrease ≥10-20 ms in iQRSd after CRT) on ventricular arrhythmia are controversial. 2 In contrast, MRR is associated with significantly improved clinical outcomes. 3 The anti-arrhythmic effect of only MRR (only mechanical reverse remodeling) in patients with moderate-severe HF, however, is still controversial. 4, 5 We recently found that both ERR and MRR (ERR+MRR) after CRT had significantly more protective effects on ventricular arrhythmia than MRR only. 6-8 It is therefore clinically important to predict C ardiac resynchronization therapy (CRT) is the standard treatment for heart failure (HF) with baseline QRS morphology matching complete left bundle branch block (CLBBB) with prolonged intrinsic QRS duration (iQRSd). Background: The development of both electrical reverse remodeling and mechanical reverse remodeling (ERR+MRR) after cardiac resynchronization therapy (CRT) implantation could reduce the incidence of lethal arrhythmia, hence the prediction of ERR+MRR is clinically important.

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Effect of QRS Narrowing After Cardiac Resynchronization Therapy on Functional Mitral Regurgitation in Patients With Systolic Heart Failure

Cited by 19 publications

References 25 publications

Predicting response to cardiac resynchronization therapy: Use of strict left bundle branch block criteria

Predicting response to cardiac resynchronization therapy: Use of strict left bundle branch block criteria

Narrowing filtered QRS duration on signal‐averaged electrocardiogram predicts outcomes in cardiac resynchronization therapy patients with nonischemic heart failure

Prediction of Both Electrical and Mechanical Reverse Remodeling on Acute Electrocardiogram Changes After Cardiac Resynchronization Therapy

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