Delta QRS and outcomes post CRT in the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial.
Journal
Heart rhythm
ISSN: 1556-3871
Titre abrégé: Heart Rhythm
Pays: United States
ID NLM: 101200317
Informations de publication
Date de publication:
09 Oct 2024
09 Oct 2024
Historique:
received:
22
07
2024
revised:
30
09
2024
accepted:
04
10
2024
medline:
12
10
2024
pubmed:
12
10
2024
entrez:
11
10
2024
Statut:
aheadofprint
Résumé
Amongst patients with left ventricular systolic dysfunction and prolonged QRS duration, cardiac resynchronization therapy (CRT) can improve cardiac electromechanical synchrony, and prevent adverse clinical outcomes. To investigate the role of delta QRS duration (ΔQRSd) in predicting clinical response to CRT. The RAFT (Resynchronization-Defibrillation for Ambulatory Heart Failure Trial) study randomized 1798 patients to CRT with defibrillator or implantable cardioverter-defibrillator (ICD) alone. Those who received CRT and had electrocardiograms available at baseline and post CRT implantation were included in this analysis. ΔQRSd was calculated as the absolute difference between QRS duration at baseline and with CRT pacing. The primary outcome was the composite of death and heart failure hospitalization. There were 813 patients included in this analysis. The median age was 67 years, and 125 patients (15.2%) were female. The median ΔQRSd was -2 ms (-20 to 18ms), and 447 (55%) of patients had a ΔQRSd ≤ 0 post implant. ΔQRSd was an independent predictor of the composite outcome amongst patients with CRT (HR = 1.012, 95% CI 1.008-1.017). CRT recipients with ΔQRSd > 0 had higher rates of the composite outcome than patients randomized to ICD alone. Amongst patients receiving CRT for heart failure with left ventricular systolic dysfunction and QRS prolongation, ΔQRSd was an independent predictor of long-term mortality and heart failure hospitalization.
Sections du résumé
BACKGROUND
BACKGROUND
Amongst patients with left ventricular systolic dysfunction and prolonged QRS duration, cardiac resynchronization therapy (CRT) can improve cardiac electromechanical synchrony, and prevent adverse clinical outcomes.
OBJECTIVES
OBJECTIVE
To investigate the role of delta QRS duration (ΔQRSd) in predicting clinical response to CRT.
METHODS
METHODS
The RAFT (Resynchronization-Defibrillation for Ambulatory Heart Failure Trial) study randomized 1798 patients to CRT with defibrillator or implantable cardioverter-defibrillator (ICD) alone. Those who received CRT and had electrocardiograms available at baseline and post CRT implantation were included in this analysis. ΔQRSd was calculated as the absolute difference between QRS duration at baseline and with CRT pacing. The primary outcome was the composite of death and heart failure hospitalization.
RESULTS
RESULTS
There were 813 patients included in this analysis. The median age was 67 years, and 125 patients (15.2%) were female. The median ΔQRSd was -2 ms (-20 to 18ms), and 447 (55%) of patients had a ΔQRSd ≤ 0 post implant. ΔQRSd was an independent predictor of the composite outcome amongst patients with CRT (HR = 1.012, 95% CI 1.008-1.017). CRT recipients with ΔQRSd > 0 had higher rates of the composite outcome than patients randomized to ICD alone.
CONCLUSION
CONCLUSIONS
Amongst patients receiving CRT for heart failure with left ventricular systolic dysfunction and QRS prolongation, ΔQRSd was an independent predictor of long-term mortality and heart failure hospitalization.
Identifiants
pubmed: 39393749
pii: S1547-5271(24)03426-X
doi: 10.1016/j.hrthm.2024.10.011
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024. Published by Elsevier Inc.