Key result
Left bundle branch block morphology, but not QRS duration ≥150 ms, was significantly associated with better long-term survival after CRT (HR 0.737; 95% CI 0.584-0.931; P=0.010).
Why the study?
Does QRS morphology or QRS duration predict long-term survival in heart failure patients treated with cardiac resynchronization therapy?
Cohort (n=973)
Does QRS morphology or QRS duration predict long-term survival in heart failure patients treated with cardiac resynchronization therapy?
Effect estimate: HR 0.737 (95% CI 0.584-0.931)
p-value: p=0.010
In heart failure patients receiving CRT, LBBB morphology, but not QRS duration ≥150 ms, is independently associated with improved long-term survival.
LBBB morphology may aid CRT prognosis in HF; leaves open whether it should guide selection pending randomized confirmation.
Aims The prognostic implications of QRS duration and morphology in heart failure patients treated with cardiac resynchronization therapy (CRT) remains debated. The present evaluation investigated the association between QRS duration (<150 vs. ≥150 ms) and QRS morphology (left bundle brand block [LBBB] vs. non-LBBB) and long-term prognosis of a large cohort of unselected heart failure patients treated with CRT according to contemporary guidelines. Methods and results Of 973 heart failure patients treated with CRT (mean age 66.1 ± 9.8 years, 76% male), 658 patients (68%) showed QRS duration ≥150 ms, and 772 patients (79%) had LBBB configuration. Compared with patients with QRS duration <150 ms, patients with QRS duration ≥150 ms had less frequently ischaemic cardiomyopathy and atrial fibrillation and showed larger left ventricular volumes and lower left ventricular ejection fraction. Compared with patients with non-LBBB configuration, patients with LBBB morphology were younger, less often males and less often had ischaemic cardiomyopathy and atrial fibrillation. On multivariable analysis, after correcting for relevant clinical and echocardiographic variables, LBBB morphology was significantly associated with better survival [hazard ratio (HR) 0.737; 95% confidence interval (CI) 0.584–0.931; P = 0.010], whereas there was no statistically significant association between QRS duration ≥150 ms and survival (HR 0.889; 95% CI 0.726–1.088; P = 0.252). Conclusions In this large population of heart failure patients treated with CRT, QRS morphology was independently associated with long-term survival. The association between QRS duration and long-term survival was not statistically significant.
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Khidir et al. (2016) conducted a cohort in Heart failure (n=973). Left bundle branch block (LBBB) morphology vs. Non-LBBB morphology was evaluated on Long-term survival (HR 0.737, 95% CI 0.584-0.931, p=0.010). Left bundle branch block morphology, but not QRS duration ≥150 ms, was significantly associated with better long-term survival after CRT (HR 0.737; 95% CI 0.584-0.931; P=0.010).