Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/13982
Title: Differential Response to Cardiac Resynchronization Therapy and Clinical Outcomes According to QRS Morphology and QRS Duration
Authors: DUPONT, Matthias 
Rickard, John
Baranowski, Bryan
Varma, Niraj
Dresing, Thomas
Gabi, Alaa
Finucan, Michael
MULLENS, Wilfried 
Wilkoff, Bruce L.
Tang, W. H. Wilson
Issue Date: 2012
Publisher: ELSEVIER SCIENCE INC
Source: JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 60 (7), p. 592-598
Abstract: Objectives The goal of this study was to examine the relative impact of QRS morphology and duration in echocardiographic responses to cardiac resynchronization therapy (CRT) and clinical outcomes. Background At least one-third of all patients treated with CRT fail to derive benefit. Patients without left bundle branch block (LBBB) or patients with smaller QRS duration (QRSd) respond less or not at all to CRT. Methods We retrospectively assessed baseline characteristics, clinical and echocardiographic response, and outcomes of all patients who received CRT at our institution between December 2003 and July 2007. Patients were stratified into 4 groups according to their baseline QRS morphology and QRSd. Results A total of 496 patients were included in the study; 216 (43.5%) had LBBB and a QRSd >= 150 ms, 85 (17.1%) had LBBB and QRSd <150 ms, 92 (18.5%) had non-LBBB and a QRSd >150 ms, and 103 (20.8%) had non-LBBB and QRSd <150 ms. Echocardiographic response (change in ejection fraction) was better in patients with LBBB and QRSd >= 150 ms (12 +/- 12%) than in those with LBBB and QRSd <150 ms (8 +/- 10%), non-LBBB and QRSd >= 150 ms (5 +/- 9%), and non-LBBB and QRSd <150 ms (3 +/- 11%) (p < 0.0001). In a multivariate step-wise model with change in ejection fraction as the dependent variable, the presented classification was the most important independent variable (p = 0.0003). Long-term survival was better in LBBB patients with QRSd >= 150 ms (p = 0.02), but this difference was not significant after adjustment for other baseline characteristics (p = 0.15). Conclusions QRS morphology is a more important baseline electrocardiographic determinant of CRT response than QRSd. (J Am Coll Cardiol 2012; 60: 592-8) (C) 2012 by the American College of Cardiology Foundation
Notes: Tang, WHW (reprint author), Cleveland Clin, Inst Heart & Vasc, Dept Cardiovasc Med, 9500 Euclid Ave,J3-4, Cleveland, OH 44195 USA.[Dupont, Matthias; Rickard, John; Baranowski, Bryan; Varma, Niraj; Dresing, Thomas; Gabi, Alaa; Finucan, Michael; Wilkoff, Bruce L.; Tang, W. H. Wilson] Cleveland Clin, Inst Heart & Vasc, Dept Cardiovasc Med, Cleveland, OH 44195 USA. [Mullens, Wilfried] Hasselt Univ, Doctoral Sch Med & Life Sci, Diepenbeek, Belgium. [Mullens, Wilfried] Ziekenhuis Oost Limburg, Dept Cardiol, Genk, Belgium. tangw@ccf.org
Keywords: Cardiac & Cardiovascular Systems; cardiac resynchronization therapy; heart failure; left bundle branch block; QRS duration;cardiac resynchronization therapy; heart failure; left bundle branch block; QRS duration
Document URI: http://hdl.handle.net/1942/13982
ISSN: 0735-1097
e-ISSN: 1558-3597
DOI: 10.1016/j.jacc.2012.03.059
ISI #: 000307463700005
Category: A1
Type: Journal Contribution
Appears in Collections:Research publications

Files in This Item:
File Description SizeFormat 
dupont 1.PDF
  Restricted Access
published version791.49 kBAdobe PDFView/Open    Request a copy
Show full item record

SCOPUSTM   
Citations

76
checked on Sep 3, 2020

WEB OF SCIENCETM
Citations

85
checked on Nov 26, 2022

Page view(s)

80
checked on Jul 22, 2022

Download(s)

72
checked on Jul 22, 2022

Google ScholarTM

Check

Altmetric


Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.