The QRS narrowing index predicts reverse left ventricular remodeling following cardiac resynchronization therapy

John Rickard, Zoran Popovic, David Verhaert, Dan Sraow, Bryan Baranowski, David O Martin, Bruce D Lindsay, Niraj Varma, Patrick Tchou, Richard A Grimm, Bruce L Wilkoff, Mina K Chung
Pacing and Clinical Electrophysiology: PACE 2011, 34 (5): 604-11

BACKGROUND: The relationship between QRS narrowing and response to cardiac resynchronization therapy (CRT) has been controversial.

OBJECTIVE: We sought to analyze the relationship between QRS narrowing and reverse remodeling in patients undergoing CRT, taking into account potential confounders including pre-CRT QRS duration and underlying QRS morphology.

METHODS: We reviewed pre- and postimplant electrocardiograms and echocardiograms in a cohort of 233 patients undergoing the new implantation of a CRT device between December 2001 and September 2006. For inclusion in the final cohort, patients had New York Heart Association classes II-IV heart failure, left ventricular ejection fraction (LVEF) ≤ 40%, and QRS duration ≥120 ms. Response to CRT was defined as a reduction in left ventricular end-systolic volume (LVESV) of ≥10%. A multivariate model was constructed to determine the relationship between QRS change and response to CRT.

RESULTS: Patients with QRS narrowing had significantly greater reductions in left ventricular end-diastolic volume (LVEDV) (mL) (-26.5 ± 52.5 vs -4.8 ± 44.0, P = 0.002) and LVESV (mL) (-34.0 ± 55.5 vs -9.9 ± 45.8, P = 0.002) and improvement in LVEF (%) (8.9 ± 12.8 vs 4.5 ± 9.0, P = 0.007) than patients without narrowing. In univariate analysis, female gender (P = 0.0002), percent QRS narrowing from baseline (P = 0.008), lack of nitrate (P≤0.0001) and antiarrhythmic medication use (P = 0.01), lack of a nonspecific intraventricular conduction delay (=0.02), nonischemic cardiomyopathy (P = 0.003), and lower pre-CRT LVEDV (P = 0.006) and LVESV [P = 0.01]) were associated with responders. In a multivariate model, QRS narrowing, indexed to the baseline QRS duration, remained strongly associated with response (odds ratio 0.08 [0.01-0.56], P = 0.01).

CONCLUSIONS: After adjusting for potential confounders, QRS narrowing, indexed to baseline QRS duration, is associated with enhanced reverse ventricular remodeling following CRT.

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