Key result
Narrow QRS in CRT links to similar mortality but higher HF hospitalization versus broad QRS.
Why the study?
Does cardiac resynchronization therapy (CRT) yield different long-term outcomes in heart failure patients with narrow QRS (≤ 120 ms) compared to those with broad QRS (> 120 ms)?
Cohort (n=297)
Does cardiac resynchronization therapy (CRT) yield different long-term outcomes in heart failure patients with narrow QRS (≤ 120 ms) compared to those with broad QRS (> 120 ms)?
Hazard Ratio: 1.05 (95% CI 0.66–1.67)
Absolute Event Rate: 25.6% vs 23.8%
p-value: p=0.85
In heart failure patients receiving CRT, those with a narrow QRS (≤ 120 ms) experience similar mortality but higher heart failure hospitalization rates compared to those with a broad QRS, supporting guidelines that prioritize CRT for broad QRS patients.
Cautions against CRT in narrow QRS HF; leaves open need for randomized confirmation of hospitalization risk.
Introduction There are few registries for narrow QRSd ≤ 120 ms patients treated with cardiac resynchronization therapy (CRT). We report longterm outcomes for patients with narrow QRSd ≤ 120 ms compared to broad > 120 ms patients.Methods The study included 297 heart failure patients with a CRT device implanted from 2001 to 2012. LV reverse remodelling (reduction in LV end-systolic volume, LVESV, of < 15%), rates of hospitalization for heart failure and all-cause mortality were studied.Results There were 121 narrow QRSd ≤ 120 ms and 176 QRSd < 120 ms patients. There was no difference in LVESV (> 15%) reduction comparing narrow and broad QRSd groups (relative risk 0.87, 95% CI 0.69-1.09, P= 0.24) between 6 to 18 months. The relative risk for hospitalization comparing narrow and broad QRSd patients was 1.18 (95% CI 1.06-1.30, P < 0.01). With a mean follow-up of 3.9 years, there were 31 (25.6%) deaths in the QRSd ≤ 120 ms group and 42 (23.8%) deaths in the QRSd < 120 ms group. Survival analysis showed no significant difference between the two groups [hazard ratio, HR 1.05 (0.66-1.67), P= 0.85].Conclusions We found that narrow QRSd ≤ 120 ms patients treated with CRT have a similar rate of LV reverse remodelling and mortality, but a higher rate of hospitalization when compared to broad QRSd < 120 ms patients.
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Yap et al. (2016) conducted a cohort in Heart failure (n=297). Narrow QRSd ≤ 120 ms vs. Broad QRSd > 120 ms was evaluated on All-cause mortality (HR 1.05, 95% CI 0.66-1.67, p=0.85). Narrow QRS (≤120 ms) in heart failure patients treated with CRT was associated with similar mortality (HR 1.05; 95% CI 0.66-1.67) but higher hospitalization rates compared to broad QRS.
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