Myocardial scar assessed by the Selvester score on preimplant ECG independently predicted nonresponse to CRT in heart failure patients with true-LBBB and LVEF ≤35%.
Cohort (n=178)
Does the Selvester score or fragmented QRS on preimplant ECG predict response to CRT in heart failure patients with true LBBB?
The Selvester score on preimplant ECG can independently predict echocardiographic nonresponse to CRT in heart failure patients with true LBBB, but it does not predict long-term clinical outcomes.
PURPOSE: Myocardial scar is directly related to the response to CRT after implantation. The extent of myocardial scar can be detected not only by cardiac magnetic resonance but also by two electrocardiographic scores: fragmented QRS (fQRS) and Selvester score (SSc). The aim of our study is to compare the role of baseline SSc and fQRS in predicting response to CRT in a cohort of heart failure patients with true left bundle branch block (LBBB). As a secondary endpoint, we assessed the association of both scores with overall and cardiac mortality, heart failure hospitalizations, ventricular arrhythmias requiring ICD intervention, and major adverse cardiovascular event (MACE). METHODS: We evaluated fQRS and SSc of 178 consecutive HF patients with severe systolic dysfunction (LVEF ≤ 35%), NYHA class II-III despite optimal medical treatment, and true-LBBB. Response to CRT was defined as the improvement of LVEF of at least 10% or as the reduction of LVESV of at least 15% at a 6-month follow-up. Each endpoint was related to fQRS and SSc. RESULTS: =0.742). No correlation was found between SSc and overall mortality, cardiac death, ventricular arrhythmias, hospitalizations due to heart failure, or for MACE. Similar results were observed between fQRS and all secondary endpoints. CONCLUSION: In HF patients with true-LBBB and LVEF ≤35% eligible for CRT, myocardial scar assessed by calculating the SSc on preimplant ECG is an independent predictor of nonresponse after multiple adjustments. Neither SSc nor fQRS is associated with overall and cardiac death, ventricular arrhythmias, or hospitalization for heart failure at a 24-month follow-up.
Nesti et al. (Mon,) conducted a cohort in Heart failure with true left bundle branch block (LBBB) (n=178). Selvester score (SSc) and fragmented QRS (fQRS) on preimplant ECG was evaluated on Response to CRT (improvement of LVEF ≥10% or reduction of LVESV ≥15% at 6-month follow-up). Myocardial scar assessed by the Selvester score on preimplant ECG independently predicted nonresponse to CRT in heart failure patients with true-LBBB and LVEF ≤35%.