Frequency of left ventricular dyssynchrony in patients with heart failure and a narrow QRS complex

Bleeker, Gabe B.; Schalij, Martin J.; Molhoek, Sander G.; Holman, Eduard R.; Verwey, Harriëtte F.; Steendijk, Paul; Wall, Ernst E. van der; Bax, Jeroen J.

doi:10.1016/j.amjcard.2004.08.082

Cited by 111 publications

(80 citation statements)

References 8 publications

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“…12 Interestingly, Bleeker et al found that 70% of patients with QRS-duration of >150ms showed severe mechanical dyssynchrony compared with only 27% of patients with a normal QRS duration. When QRS-duration was taken as a continuous variable, however, there was no relationship between QRS-duration and the extent of intraventricular dyssynchrony, 13 which was further supported by a study by Yu et al 14 Considering that 27% of patients despite a narrow QRS complex exhibit significant intraventricular dyssynchrony by TDI, it is intriguing to speculate that these patients would also respond beneficially to CRT. This has been investigated in two smaller studies including 33 and 51 patients with QRS < 120ms.…”

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confidence: 64%

Cardiac resynchronization therapy in patients with a narrow QRS

Holzmeister

Hürlimann²,

Steffel³

et al. 2009

Curr Heart Fail Rep

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Although cardiac resynchronization therapy (CRT) is indicated in patients with moderate to severe heart failure with a wide QRS complex (> 120 ms), current guidelines exclude many heart failure patients with a narrow QRS. Detecting mechanical dyssynchrony on echocardiography has become a promising tool in selecting patients with a narrow QRS who may respond to CRT. Several small single-center studies identified patients with a narrow QRS (using echocardiography-based dyssynchrony criteria) who responded favorably to CRT; however, the results of two recent pilot studies remain elusive. The results of the RethinQ study do not provide necessary evidence for making clinical treatment decisions in this population. The lack of definitive evidence is the strongest rationale for conducting an adequately powered, long-term, end point-driven, randomized controlled trial to investigate whether CRT therapy can improve morbidity and mortality outcomes in heart failure patients with a narrow QRS. Such a trial, the EchoCRT trial, has recently been launched. AbstractWhile cardiac resynchronization therapy (CRT) is indicated in patients with moderateto-severe heart failure with a wide QRS complex (> 120 ms), current guidelines exclude a substantial number of patients with a narrow QRS. Detection of mechanical dyssynchrony on echocardiography has emerged as a promising tool to select patients with narrow QRS that may respond to CRT. While several small single center studies were able to identify patients with narrow QRS using echocardiography-based dyssynchrony criteria, who responded favorably to CRT, the results of two recent pilot studies remain elusive. Especially the initial experience from the RethinQ study does not provide the evidence necessary for making clinical treatment decisions in this population. This lack of definitive evidence is the strongest rationale for conducting an adequately powered, long-term, endpoint-driven, randomized controlled trial to investigate whether CRT therapy can improve morbidity and mortality outcomes in the large number of heart failure patients with narrow QRS, which has recently been launched.(156 words) 2

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mentioning

confidence: 64%

Cardiac resynchronization therapy in patients with a narrow QRS

Holzmeister

Hürlimann²,

Steffel³

et al. 2009

Curr Heart Fail Rep

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“…Conversely, as observed in this study, it was also demonstrated in many studies that Section: Medicine 20% -50% of heart failure patients with QRS duration (<120ms) may also exhibit LV dyssynchrony and these patients may benefit from CRT. [12][13][14] Recently, the RethinQ (Cardiac Resynchronization Therapy in Patients with Heart Failure and Narrow QRS) study was published looking at CRT in 172 patients with heart failure (EF 35%), and a narrow QRS complex, but With mechanical dyssynchrony, with the majority of patients (96%) enrolled based on the opposite wall delay method by colour tissue Doppler imaging (15). In study, CRT did not result in a significant change in peak oxygen consumption (primary end point), Minnesota Living with Heart Failure score, 6-min walk, and LV volumes/EF at 6 months.…”

Section: Discussionmentioning

confidence: 99%

A Study of Prevalence of Mechanical Dyssynchrony In Patients With Varying QRS Interval And Its Correlation With Left Ventricular Function Using Tissue Doppler Technique

Singh¹,

Singh²,

Sinha³

2017

AIMDR

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Background: Cardiac resynchronisation therapy is now established modility of treatment of dilated cardiomyopathy with wide QRS (LBBB) duration who are refractory to medical therapy. However a significant a significant number of patients are responder to this therapy also. On the contrary about 40% patient's dilated cardiomyopathy having narrow QRS do better with cardiac resynchronisation therapy. However the true prevalence of interventricular and intraventricular dyssynchrony in broad set of dilated cardiomyopathy and its relation with LV function has not been assessed using newer techniques. The present study is designed to assess the prevalence of interventricular and intraventricular dyssynchrony in dilated cardiomyopathy patients with varying QRS duration also, its relation with left ventricular function with tissue Doppler techniques. Methods & Results: Fifty nine consecutive patients of dilated cardiomyopathy having ejection fraction ≤45% with varying qrs duration and 20 patients having normal left ventricular function with wide QRS duration were studied. The patients were then grouped as group A dilated cardiomyopathy having wide qrs interval , group B dilated cardiomyopathy with narrow QRS and group C having normal left ventricular function with left bundle branch block. The interventricular and intraventricular` were assessed in apical four chamber , 2 chamber and long axis view Using colour coded B mode tissue Doppler technique. Data were analysed offline and the standard reported parameters were used for defining interventricular and intraventricular dyssynchrony. The interventricular dyssynchrony was present in significant proportion of patient of group a, group B and group C. It was present was present in 78 % of group A, 68.7% in group B and 60 % of group C. The prevalence of intraventricular dyssynchrony was present was present in 68.7 % of group A, 48% in group B and 5 % of group C. There was significant positive correlation between QRS width and intraventricular dyssynchrony was observed (r =.342, p=0.008) in dilated cardiomyopathy patients irrespective of QRS duration. There was statistically significant interaction when intraventricular dyssynchrony and QRS width (r = 0.652, p<.001) analysed in among group A, however it was no significant in group B (P=0.68) individually. There was significant correlation between LV dyssynchrony and left ventricular ejection fraction. r = -.303 p=0.014 as this association is no as robust as the QRS width. Conclusion: We concluded that there is quite good correlation between left ventricular dyssynchrony and QRS duration in patients of dilated cardiomyopathy. There is also weak correlation between intraventricular dyssynchrony and left ventricular ejection fraction irrespective of QRS duration.

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“…Bleeker, et al evaluated cardiac echocardiography in patients with a narrow QRS complex and found severe LV dyssynchrony in a third of these patients. 15) However, in clinical practice, it is difficult to assess cardiac dyssynchrony in patients with very poor cardiac wall motion. It is possible that cardiac dyssynchrony is underestimated when LV function is very low.…”

Section: Discussionmentioning

confidence: 99%

Dramatic Response to Cardiac Resynchronization Therapy With AV Delay Optimization in Narrow QRS Heart Failure

et al. 2015

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SummaryCardiac resynchronization therapy (CRT) has been shown to be effective for heart failure. However, as outlined in the AHA/ACC/HRS Appropriate Use Criteria, CRT is not strongly recommended for patients with a narrow QRS complex. We describe a case of dilated cardiomyopathy and narrow QRS complex in which we obtained a dramatic response to CRT by optimizing the atrioventricular (AV) delay. The patient was a 61-year-old man with intractable heart failure. Echocardiography showed a low ejection fraction of 22% but no dyssynchrony. Because he had been hospitalized many times for congestive heart failure despite β-blocker and diuretic treatment, we decided to use CRT. However, after implantation of the CRT device, the QRS complex widened abnormally, and his symptoms worsened. He was re-admitted 2 months after CRT implantation. We examined the pacemaker status and optimized the AV delay to obtain a "narrow" QRS complex. The patient's condition improved dramatically after the AV delay optimization. His clinical status has been good, and there has been no subsequent hospitalization. Our case points to the effectiveness of CRT in patients with a narrow QRS complex and to the importance of AV optimization for successful CRT. (Int Heart J 2015; 56: 671-675) Key words: CRT responder, Narrow QRS complex, Dilated cardiomyopathy T he effectiveness of cardiac resynchronization therapy (CRT) is well understood in cases of heart failure with a wide QRS complex ≥ 150 ms. Whether CRT is effective in patients with a narrow QRS complex is controversial, and its application in such patients is not usually recommended. However, in clinical practice, we often see patients with severe heart failure and a narrow QRS, and these patients are generally not considered candidates for CRT. Thus, it is difficult to manage these patients. Here, we present a case of dilated cardiomyopathy with a narrow QRS complex that was treated successfully by CRT with AV optimization. The good outcome achieved in this case points to the possibility of expanding CRT beyond current guidelines. Case ReportA 61-year-old man with dilated cardiomyopathy was referred to our hospital because of drug-refractory heart failure. Echocardiography showed an enlarged left ventricle with a low ejection fraction of 22%, and New York Heart Association (NYHA) class III heart failure was noted. His plasma B-type natriuretic peptide (BNP) concentration was 1793 pg/mL. Sinus rhythm with a narrow QRS complex of 112 ms was seen on the electrocardiogram (ECG) (Figure 1). Despite β-blocker (carvedilol), diuretic (furosemide), and methyldigoxin (lanirapid) therapy, the patient had been hospitalized repeatedly for acute-congestive heart failure. The β-blocker dosage was 1.25 mg/day, which we thought might be inadequate. We attempted to increase the dosage, but the patient did not tolerate the increase well; hypotension and dizziness ensued. Therefore, although the QRS complex was narrow, we decided to apply cardiac resynchronization therapy (CRT) before trying again to increase ...

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Frequency of left ventricular dyssynchrony in patients with heart failure and a narrow QRS complex

Cited by 111 publications

References 8 publications

Cardiac resynchronization therapy in patients with a narrow QRS

Cardiac resynchronization therapy in patients with a narrow QRS

A Study of Prevalence of Mechanical Dyssynchrony In Patients With Varying QRS Interval And Its Correlation With Left Ventricular Function Using Tissue Doppler Technique

Dramatic Response to Cardiac Resynchronization Therapy With AV Delay Optimization in Narrow QRS Heart Failure

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