Key result
Post-CRT QRS area reduction ≥62 µVs is linked to ~57% lower mortality, transplant, or LVAD risk.
Why the study?
While baseline QRS area is known to associate with clinical response after CRT, the association between QRS area reduction after CRT and clinical outcomes remained to be determined.
Does a larger QRS area reduction (≥62 µVs) after cardiac resynchronization therapy improve survival and echocardiographic response in patients receiving CRT?
Cohort (n=1,299)
Yes
Does a larger QRS area reduction (≥62 µVs) after cardiac resynchronization therapy improve survival and echocardiographic response in patients receiving CRT?
A reduction in QRS area ≥62 µVs after CRT is an independent predictor of improved survival and echocardiographic response, particularly in patients with a large baseline QRS area.
Answers are grounded in this paper and cite their sources.
Hypothesis-generating for QRS area reduction as post-CRT prognostic marker; prospective trials needed before clinical adoption.
INTRODUCTION: Recent studies have shown that the baseline QRS area is associated with the clinical response after cardiac resynchronization therapy (CRT). In this study, we investigated the association of QRS area reduction (∆QRS area) after CRT with the outcome. We hypothesize that a larger ∆QRS area is associated with a better survival and echocardiographic response. METHODS AND RESULTS: Electrocardiograms (ECG) obtained before and 2-12 months after CRT from 1299 patients in a multi-center CRT-registry were analyzed. The QRS area was calculated from vectorcardiograms that were synthesized from 12-lead ECGs. The primary endpoint was a combination of all-cause mortality, heart transplantation, and left ventricular (LV) assist device implantation. The secondary endpoint was the echocardiographic response, defined as LV end-systolic volume reduction ≥ of 15%. Patients with ∆QRS area above the optimal cut-off value (62 µVs) had a lower risk of reaching the primary endpoint (hazard ratio: 0.43; confidence interval [CI] 0.33-0.56, p < .001), and a higher chance of echocardiographic response (odds ratio [OR] 3.3;CI 2.4-4.6, p < .0001). In multivariable analysis, ∆QRS area was independently associated with both endpoints. In patients with baseline QRS area ≥109 µVs, survival, and echocardiographic response were better when the ∆QRS area was ≥62 µVs (p < .0001). Logistic regression showed that in patients with baseline QRS area ≥109 µVs, ∆QRS area was the only significant predictor of survival (OR: 0.981; CI: 0.967-0.994, p = .006). CONCLUSION: ∆QRS area is an independent determinant of CRT response, especially in patients with a large baseline QRS area. Failure to achieve a large QRS area reduction with CRT is associated with a poor clinical outcome.
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Ghossein et al. (2021) conducted a cohort in Heart failure (n=1,299). QRS area reduction (∆QRS area) ≥62 µVs after CRT vs. ∆QRS area <62 µVs after CRT was evaluated on Combination of all-cause mortality, heart transplantation, and left ventricular assist device (LVAD) implantation (HR 0.43, 95% CI 0.33-0.56, p=<0.001). Patients with a QRS area reduction ≥62 µVs after cardiac resynchronization therapy had a lower risk of mortality, heart transplantation, or LVAD implantation.
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