PMID- 21956038
OWN - NLM
STAT- MEDLINE
DCOM- 20120216
LR  - 20220409
IS  - 1941-3084 (Electronic)
IS  - 1941-3084 (Linking)
VI  - 4
IP  - 6
DP  - 2011 Dec
TI  - Paced left ventricular QRS width and ECG parameters predict outcomes after 
      cardiac resynchronization therapy: PROSPECT-ECG substudy.
PG  - 851-7
LID - 10.1161/CIRCEP.111.962605 [doi]
AB  - BACKGROUND: For patients with symptomatic New York Heart Association class III or 
      IV, ejection fraction </= 35%, and QRS >/= 130 ms, cardiac resynchronization therapy 
      (CRT) has become an established treatment option. However, use of these implant 
      criteria fails to result in clinical or echocardiographic improvement in 30% to 
      45% of CRT patients. METHODS AND RESULTS: The Predictors of Response to CRT 
      (PROSPECT)-ECG is a substudy of the prospective observational PROSPECT trial. 
      ECGs collected before, during, and after CRT implantation were analyzed. Primary 
      outcomes were improvement in clinical composite score (CCS) and reduction of left 
      ventricular end systolic volume (LVESV) of >15% after 6 months. Age, sex, cause 
      of cardiomyopathy, myocardial infarction location, right ventricular function, 
      mitral regurgitation, preimplantation QRS width, preimplantation PR interval, 
      preimplantation right ventricular-paced QRS width, preimplantation axis 
      categories, LV-paced QRS width, postimplantation axis categories, difference 
      between biventricular (Bi-V) pacing and preimplantation QRS width, and QRS bundle 
      branch morphological features were analyzed univariably in logistic regression 
      models to predict outcomes. All significant predictors (alpha=0.1), age, and sex were 
      used for multivariable analyses. Cardiomyopathy cause interaction and subanalyses 
      were also performed. In multivariable analyses, only QRS left bundle branch 
      morphological features predicted both CCS (odds ratio [OR]=2.46, P=0.02) and 
      LVESV (OR=2.89, P=0.048) response. The difference between Bi-V and 
      preimplantation QRS width predicted CCS improvement (OR=0.89, P=0.04). LV-paced 
      QRS width predicted LVESV reduction (OR=0.86, P=0.01). Specifically, an LV-paced 
      QRS width of </= 200 ms was predictive of nonischemic LVESV reduction (OR=5.12, 
      P=0.01). CONCLUSIONS: Baseline left bundle branch QRS morphological features, 
      LV-paced QRS width, and the difference between Bi-V and preimplantation QRS width 
      can predict positive outcomes after CRT and may represent a novel intraprocedural 
      method to optimize coronary sinus lead placement. CLINICAL TRIAL REGISTRATION: 
      URL: http://www.clinicaltrials.gov. Unique identifier: NCT00253357.
FAU - Hsing, Jeff M
AU  - Hsing JM
AD  - Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical 
      School, Boston, MA 02215, USA.
FAU - Selzman, Kimberly A
AU  - Selzman KA
FAU - Leclercq, Christophe
AU  - Leclercq C
FAU - Pires, Luis A
AU  - Pires LA
FAU - McLaughlin, Michael G
AU  - McLaughlin MG
FAU - McRae, Scott E
AU  - McRae SE
FAU - Peterson, Brett J
AU  - Peterson BJ
FAU - Zimetbaum, Peter J
AU  - Zimetbaum PJ
LA  - eng
SI  - ClinicalTrials.gov/NCT00253357
PT  - Clinical Trial
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20110928
PL  - United States
TA  - Circ Arrhythm Electrophysiol
JT  - Circulation. Arrhythmia and electrophysiology
JID - 101474365
SB  - IM
MH  - *Cardiac Pacing, Artificial
MH  - *Cardiac Resynchronization Therapy/adverse effects
MH  - *Electrocardiography
MH  - *Electrophysiologic Techniques, Cardiac
MH  - Europe
MH  - Female
MH  - Heart Failure/*diagnosis/physiopathology/*therapy
MH  - Hong Kong
MH  - Humans
MH  - Logistic Models
MH  - Male
MH  - Odds Ratio
MH  - Patient Selection
MH  - Predictive Value of Tests
MH  - Prospective Studies
MH  - Recovery of Function
MH  - Risk Assessment
MH  - Risk Factors
MH  - Stroke Volume
MH  - Time Factors
MH  - Treatment Outcome
MH  - United States
MH  - *Ventricular Function, Left
EDAT- 2011/10/01 06:00
MHDA- 2012/02/18 06:00
CRDT- 2011/09/30 06:00
PHST- 2011/09/30 06:00 [entrez]
PHST- 2011/10/01 06:00 [pubmed]
PHST- 2012/02/18 06:00 [medline]
AID - CIRCEP.111.962605 [pii]
AID - 10.1161/CIRCEP.111.962605 [doi]
PST - ppublish
SO  - Circ Arrhythm Electrophysiol. 2011 Dec;4(6):851-7. doi: 
      10.1161/CIRCEP.111.962605. Epub 2011 Sep 28.