Key result
In Japanese patients receiving cardiac resynchronization therapy, intrinsic left bundle branch block with QRS duration ≥150 ms was associated with the lowest incidence of all-cause death or heart failure hospitalization compared to other QRS morphologies.
Why the study?
Does intrinsic QRS morphology and duration predict clinical outcomes and echocardiographic response after cardiac resynchronization therapy in Japanese patients with heart failure?
Cohort (n=510)
Yes
Does intrinsic QRS morphology and duration predict clinical outcomes and echocardiographic response after cardiac resynchronization therapy in Japanese patients with heart failure?
In a Japanese population, patients with LBBB intrinsic QRS morphology and prolonged QRS duration (≥150 ms) exhibited the best echocardiographic and clinical responses to cardiac resynchronization therapy.
Answers are grounded in this paper and cite their sources.
May support prioritizing LBBB with QRSd ≥150 ms for CRT in Japanese patients; extends evidence but leaves open generalizability.
BACKGROUND: QRS duration (QRSd) and morphology are established response predictors of cardiac resynchronization therapy (CRT). However, evidence in Japanese populations is lacking. METHODS AND RESULTS: We retrospectively analyzed the Japanese multicenter CRT database. We divided patients according to their intrinsic QRSd and morphology, and assessed echocardiographic responses and clinical outcomes. The primary endpoint was a composite of all-cause death or hospitalization because of heart failure. A total of 510 patients were enrolled: 200 (39%) had left bundle branch block (LBBB) and QRSd ≥150 ms; 80 (16%) had LBBB (QRSd: 120-149 ms); 61 (12%) had non-LBBB (NLBBB) (QRSd: ≥150 ms); 54 (11%) had NLBBB (QRSd: 120-149 ms); 115 (23%), narrow (<120 ms). The proportion of echocardiographic responders was higher in LBBB (QRSd ≥150 ms) [74% vs. 51% vs. 38% vs. 52% vs. 50%, LBBB (QRSd ≥150 ms) vs. LBBB (QRSd 120-149 ms) vs. NLBBB (QRSd ≥150 ms) vs. NLBBB (QRSd 120-149 ms) vs. narrow, respectively, P<0.001]. During follow-up (3.2±1.5 years), the incidence of the primary endpoint was lowest in the LBBB group (QRSd ≥150) (28.6% vs. 42.3% vs. 45.9% vs. 55.6% vs. 55.3%, respectively, P<0.001). This difference was still significant after adjusting for other baseline characteristics. CONCLUSIONS: In this Japanese patient population, LBBB intrinsic QRS morphology and prolonged QRSd (≥150 ms) exhibited the best response to CRT.
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Oka et al. (2018) conducted a cohort in Heart failure with reduced ejection fraction (n=510). Cardiac resynchronization therapy (CRT) in patients with LBBB and QRSd ≥150 ms vs. CRT in patients with narrow QRS complex (<120 ms) was evaluated on Composite of all-cause death or hospitalization because of heart failure (HR 2.50, 95% CI 1.72-3.63, p=<0.001). In Japanese patients receiving cardiac resynchronization therapy, intrinsic left bundle branch block with QRS duration ≥150 ms was associated with the lowest incidence of all-cause death or heart failure hospitalization compared to other QRS morphologies.
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