Patients with advanced heart failure and QRS duration ≥140 msec had a significantly higher prevalence of paradoxical septal motion compared to those with QRS <140 msec (80% vs 28%, P=0.0005).
Observational (n=50)
Are there differences in echocardiographic features, specifically paradoxical septal motion, between advanced CHF patients with and without prolonged QRS duration?
Paradoxical septal motion on echocardiography is significantly more common in CHF patients with prolonged QRS duration, suggesting echo may help identify candidates for biventricular pacing.
Absolute Event Rate: 80% vs 28%
p-value: p=0.0005
BACKGROUND: Recent studies suggest that cardiac resynchronization therapy through biventricular pacing (BVP) may be a promising new treatment for patients with advanced congestive heart failure (CHF). This method involves implantation of pacer leads into the right atrium (RA), right ventricle (RV), and coronary sinus (CS) in patients with ventricular dyssynchrony as evidenced by a bundle branch block pattern on electrocardiogram (ECG). Clinical trials are enrolling stable patients with ejection fractions (EF) /= 54 mm, and QRS duration >/=140 msec. We compared echocardiography features of these patients (group 1) with other patients with EF /= 54 mm, and QRS < 140 msec (group 2 = presumably no dyssynchrony). METHODS: Nine hundred fifty-one patients with CHF, LVID 54 mm, EF 35% by echocardiography were retrospectively evaluated. One hundred forty-five patients remained after those with primary valvular disease, prior pacing systems, or chronic atrial arrhythmias were excluded. From this group of 145 patients, a subset of 50 randomly selected patients were further studied (25 patients 7 females, 18 males from group 1, and 25 patients 7 females, 18 males from group 2). Mean age group 1 = 75 years old, mean age group 2 = 67 years old. Mean QRS group 1 = 161 msec, mean QRS group 2 = 110 msec. Each group was compared for presence of paradoxical septal motion, atrial and ventricular chamber sizes, LV mass, LVEF, and RV systolic function. RESULTS: Of the initial group of 951 patients, 145 (15%) met inclusion criteria. In the substudy, 20/25 (80%) of group l and 7/25 (28%) of group 2 subjects had paradoxical septal motion on echo (Fisher's exact test, P = 0.0005). The t-tests performed on the other echocardiography variables demonstrated no differences in chamber size, function, or LV mass. CONCLUSIONS: Cardiac resynchronization therapy with BVP appears to target a relatively small population of our advanced CHF patients (15% or less). Although increasing QRS duration on ECG is associated with more frequent paradoxical septal motion on echo, it is not entirely predictive. Paradoxical septal motion on echo may therefore be more sensitive at identifying patients who respond to BVP. Further prospective studies are needed.
Makaryus et al. (Tue,) conducted a observational in Congestive heart failure (n=50). QRS duration ≥ 140 msec vs. QRS duration < 140 msec was evaluated on Paradoxical septal motion on echocardiography (p=0.0005). Patients with advanced heart failure and QRS duration ≥140 msec had a significantly higher prevalence of paradoxical septal motion compared to those with QRS <140 msec (80% vs 28%, P=0.0005).
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