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

doi:10.1111/j.1540-8159.2010.03022.x

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

Research output: Contribution to journal › Article › peer-review

49 Scopus citations

Abstract

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 enddiastolic 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.

Original language	English (US)
Pages (from-to)	604-611
Number of pages	8
Journal	PACE - Pacing and Clinical Electrophysiology
Volume	34
Issue number	5
DOIs	https://doi.org/10.1111/j.1540-8159.2010.03022.x
State	Published - May 2011
Externally published	Yes

Keywords

CRT
Congestive heart failure
Electrophysiology-clinical

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1111/j.1540-8159.2010.03022.x

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Rickard, J., Popovic, Z., Verhaert, D., Sraow, D., Baranowski, B., Martin, D. O., Lindsay, B. D., Varma, N., Tchou, P., Grimm, R. A., Wilkoff, B. L., & Chung, M. K. (2011). The QRS narrowing index predicts reverse left ventricular remodeling following cardiac resynchronization therapy. PACE - Pacing and Clinical Electrophysiology, 34(5), 604-611. https://doi.org/10.1111/j.1540-8159.2010.03022.x

Rickard, J, Popovic, Z, Verhaert, D, Sraow, D, Baranowski, B, Martin, DO, Lindsay, BD, Varma, N, Tchou, P, Grimm, RA, Wilkoff, BL & Chung, MK 2011, 'The QRS narrowing index predicts reverse left ventricular remodeling following cardiac resynchronization therapy', PACE - Pacing and Clinical Electrophysiology, vol. 34, no. 5, pp. 604-611. https://doi.org/10.1111/j.1540-8159.2010.03022.x

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title = "The QRS narrowing index predicts reverse left ventricular remodeling following cardiac resynchronization therapy",

abstract = "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 enddiastolic 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.",

keywords = "CRT, Congestive heart failure, Electrophysiology-clinical",

author = "John Rickard and Zoran Popovic and David Verhaert and Dan Sraow and Bryan Baranowski and Martin, {David O.} and Lindsay, {Bruce D.} and Niraj Varma and Patrick Tchou and Grimm, {Richard A.} and Wilkoff, {Bruce L.} and Chung, {Mina K.}",

year = "2011",

month = may,

doi = "10.1111/j.1540-8159.2010.03022.x",

language = "English (US)",

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T1 - The QRS narrowing index predicts reverse left ventricular remodeling following cardiac resynchronization therapy

AU - Rickard, John

AU - Popovic, Zoran

AU - Verhaert, David

AU - Sraow, Dan

AU - Baranowski, Bryan

AU - Martin, David O.

AU - Lindsay, Bruce D.

AU - Varma, Niraj

AU - Tchou, Patrick

AU - Grimm, Richard A.

AU - Wilkoff, Bruce L.

AU - Chung, Mina K.

PY - 2011/5

Y1 - 2011/5

N2 - 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 enddiastolic 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.

AB - 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 enddiastolic 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.

KW - CRT

KW - Congestive heart failure

KW - Electrophysiology-clinical

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

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