A possible easy way to predict response to cardiac resynchronization therapy: The role of QRS Index
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Abstract
Background: Some studies have evaluated the role of QRS duration (QRSd) as predictor of response to Cardiac Resynchronization Therapy (CRT). However, their results are still not entirely clear. The goal of our study was to determine the correlation between the relative change in QRS narrowing index (QI) compared to clinical outcome and prognosis in patients who underwent CRT implantation.
Methods: We collected clinical and echocardiographic data of 115 patients in whome a CRT device was implanted in accordance with current guidelines. QRS duration before and after CRT implantation and QI were measured.
Results: After 6 months, a significant improvement in all echocardiographic parameters was detected. QI was correlated to reverse remodelling (r = +0.19; 95% CI: 0.006 to 0.35, p = 0,049). The value of QI that predicted best LV reverse remodelling after 6 months of CRT was 12.25% (sensitivity = 65,5%, specificity = 75%, area under the curve = 0.737, p = 0,001). Independent predictors of QI are sex, serum creatinine and eGFR measured at baseline and LVEF pre-CRT performed by echocardiography.
We observed an betterment in their HF clinical composite score and NYHA class at 12 months.
We have also investigated the clinical outcomes and the possible sex differences related to QI.
Conclusions: Patients with a larger QI after CRT initiation showed greater echocardiographic reverse remodelling and better outcome from death or cardiovascular hospitalization. QI seems to be an easy-to- measure variable that could be used or evaluated to predict CRT response but further studies are needed.
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Carità P, Corrado E, Pontone G, Curnis A, Bontempi L, Novo G, Guglielmo M, Ciaramitaro G, Assennato P, Novo S, Coppola G. Non-responders to cardiac resynchronization therapy: Insights from multimodality imaging and electrocardiography. A brief review. Int J Cardiol. 2016 Dec 15;225:402-407. doi: 10.1016/j.ijcard.2016.09.037. Epub 2016 Sep 17. PMID: 27776243.
Yu CM, Bleeker GB, Fung JW, Schalij MJ, Zhang Q, van der Wall EE, Chan YS, Kong SL, Bax JJ. Left ventricular reverse remodeling but not clinical improvement predicts long-term survival after cardiac resynchronization therapy. Circulation. 2005 Sep 13;112(11):1580-6. doi: 10.1161/CIRCULATIONAHA.105.538272. Epub 2005 Sep 6. PMID: 16144994.
Menet A, Guyomar Y, Ennezat PV, Graux P, Castel AL, Delelis F, Heuls S, Cuvelier E, Gevaert C, Le Goffic C, Tribouilloy C, Maréchaux S. Prognostic value of left ventricular reverse remodeling and performance improvement after cardiac resynchronization therapy: A prospective study. Int J Cardiol. 2016 Feb 1;204:6-11. doi: 10.1016/j.ijcard.2015.11.091. Epub 2015 Nov 18. PMID: 26649446.
Stabile G, Bertaglia E, Botto G, Isola F, Mascioli G, Pepi P, Caico SI, De Simone A, D'Onofrio A, Pecora D, Palmisano P, Maglia G, Arena G, Malacrida M, Padeletti L. Cardiac Resynchronization Therapy MOdular REgistry: ECG and Rx predictors of response to cardiac resynchronization therapy (NCT01573091). J Cardiovasc Med (Hagerstown). 2013 Dec;14(12):886-93. doi: 10.2459/JCM.0b013e3283644bb2. PMID: 24149063.
Chaturvedi V. Current research on the relevance of electrocardiography in cardiac resynchronization therapy. Indian Pacing Electrophysiol J. 2015 Oct 19;15(2):145-7. doi: 10.1016/j.ipej.2015.09.001. PMID: 26937104; PMCID: PMC4750123.
Rickard J, Popovic Z, Verhaert D, Sraow D, Baranowski B, Martin DO, Lindsay BD, Varma N, Tchou P, Grimm RA, Wilkoff BL, Chung MK. The QRS narrowing index predicts reverse left ventricular remodeling following cardiac resynchronization therapy. Pacing Clin Electrophysiol. 2011 May;34(5):604-11. doi: 10.1111/j.1540-8159.2010.03022.x. Epub 2011 Jan 28. PMID: 21276023.
Coppola G, Bonaccorso P, Corrado E, Ciaramitaro G, Ajello L, Nugara C, Assennato P. The QRS narrowing index for easy and early identification of responder to cardiac resynchronization therapy. Int J Cardiol. 2014 Jan 1;170(3):440-1. doi: 10.1016/j.ijcard.2013.11.057. Epub 2013 Dec 4. PMID: 24342404.
Coppola G, Ciaramitaro G, Stabile G, DOnofrio A, Palmisano P, Carità P, Mascioli G, Pecora D, De Simone A, Marini M, Rapacciuolo A, Savarese G, Maglia G, Pepi P, Padeletti L, Pierantozzi A, Arena G, Giovannini T, Caico SI, Nugara C, Ajello L, Malacrida M, Corrado E. Magnitude of QRS duration reduction after biventricular pacing identifies responders to cardiac resynchronization therapy. Int J Cardiol. 2016 Oct 15;221:450-5. doi: 10.1016/j.ijcard.2016.06.203. Epub 2016 Jul 1. PMID: 27414720.
Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, Kusek JW, Van Lente F; Chronic Kidney Disease Epidemiology Collaboration. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med. 2006 Aug 15;145(4):247-54. doi: 10.7326/0003-4819-145-4-200608150-00004. Erratum in: Ann Intern Med. 2008 Oct 7;149(7):519. Erratum in: Ann Intern Med. 2021 Apr;174(4):584. PMID: 16908915.
Kligfield P, Gettes LS, Bailey JJ, Childers R, Deal BJ, Hancock EW, van Herpen G, Kors JA, Macfarlane P, Mirvis DM, Pahlm O, Rautaharju P, Wagner GS; American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; American College of Cardiology Foundation; Heart Rhythm Society; Josephson M, Mason JW, Okin P, Surawicz B, Wellens H. Recommendations for the standardization and interpretation of the electrocardiogram: part I: The electrocardiogram and its technology: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society: endorsed by the International Society for Computerized Electrocardiology. Circulation. 2007 Mar 13;115(10):1306-24. doi: 10.1161/CIRCULATIONAHA.106.180200. Epub 2007 Feb 23. PMID: 17322457.
Packer M. Proposal for a new clinical end point to evaluate the efficacy of drugs and devices in the treatment of chronic heart failure. J Card Fail. 2001 Jun;7(2):176-82. doi: 10.1054/jcaf.2001.25652. PMID: 11420770.
Yang XW, Hua W, Wang J, Liu ZM, Ding LG, Chen KP, Zhang S. Regression of fragmented QRS complex: a marker of electrical reverse remodeling in cardiac resynchronization therapy. Ann Noninvasive Electrocardiol. 2015 Jan;20(1):18-27. doi: 10.1111/anec.12172. Epub 2014 Jul 7. PMID: 25040593; PMCID: PMC6931476.
Bax JJ, Bleeker GB, Marwick TH, Molhoek SG, Boersma E, Steendijk P, van der Wall EE, Schalij MJ. Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy. J Am Coll Cardiol. 2004 Nov 2;44(9):1834-40. doi: 10.1016/j.jacc.2004.08.016. PMID: 15519016.
Sweeney MO, Hellkamp AS, van Bommel RJ, Schalij MJ, Borleffs CJ, Bax JJ. QRS fusion complex analysis using wave interference to predict reverse remodeling during cardiac resynchronization therapy. Heart Rhythm. 2014 May;11(5):806-13. doi: 10.1016/j.hrthm.2014.01.021. Epub 2014 Jan 22. PMID: 24462523.
Singh JP, Fan D, Heist EK, Alabiad CR, Taub C, Reddy V, Mansour M, Picard MH, Ruskin JN, Mela T. Left ventricular lead electrical delay predicts response to cardiac resynchronization therapy. Heart Rhythm. 2006 Nov;3(11):1285-92. doi: 10.1016/j.hrthm.2006.07.034. Epub 2006 Aug 10. Erratum in: Heart Rhythm. 2006 Dec;3(12):1515. PMID: 17074633.
Stabile G, D'Onofrio A, Pepi P, De Simone A, Santamaria M, Caico SI, Rapacciuolo A, Padeletti L, Pecora D, Giovannini T, Arena G, Spotti A, Iuliano A, Bertaglia E, Malacrida M, Botto GL. Interlead anatomic and electrical distance predict outcome in CRT patients. Heart Rhythm. 2015 Nov;12(11):2221-9. doi: 10.1016/j.hrthm.2015.05.020. Epub 2015 May 19. PMID: 26001509.
Dickstein K, Normand C, Auricchio A, Bogale N, Cleland JG, Gitt AK, Stellbrink C, Anker SD, Filippatos G, Gasparini M, Hindricks G, Blomström Lundqvist C, Ponikowski P, Ruschitzka F, Botto GL, Bulava A, Duray G, Israel C, Leclercq C, Margitfalvi P, Cano Ó, Plummer C, Sarigul NU, Sterlinski M, Linde C. CRT Survey II: a European Society of Cardiology survey of cardiac resynchronisation therapy in 11 088 patients-who is doing what to whom and how? Eur J Heart Fail. 2018 Jun;20(6):1039-1051. doi: 10.1002/ejhf.1142. Epub 2018 Feb 19. PMID: 29457358.
Martens P, Nijst P, Verbrugge FH, Dupont M, Tang WHW, Mullens W. Profound differences in prognostic impact of left ventricular reverse remodeling after cardiac resynchronization therapy relate to heart failure etiology. Heart Rhythm. 2018 Jan;15(1):130-136. doi: 10.1016/j.hrthm.2017.08.021. Epub 2017 Aug 24. PMID: 28843420.