PMID- 30444259
OWN - NLM
STAT- MEDLINE
DCOM- 20210817
LR  - 20210817
IS  - 1898-018X (Electronic)
IS  - 1897-5593 (Print)
IS  - 1898-018X (Linking)
VI  - 27
IP  - 5
DP  - 2020
TI  - Influence of QRS duration and axis on response to cardiac resynchronization 
      therapy in chronic heart failure with reduced left ventricular ejection fraction: 
      A single center study including patients with left bundle branch block.
PG  - 575-582
LID - 10.5603/CJ.a2018.0138 [doi]
AB  - BACKGROUND: The aim of the study was to evaluate QRS duration and axis as 
      predictors of response to cardiac resynchronization therapy (CRT) in order to 
      reduce the proportion of non-responders. METHODS: Retrospective single-center 
      study including 42 CRT recipients, with left bundle branch block (LBBB), left 
      ventricular ejection fraction (LVEF) < 40%, in New York Heart Association (NYHA) 
      class >/= II. Response to CRT was declared as NYHA class improvement >/= 1 
      (symptomatic) and LVEF improvement by >/= 10% (echocardiographic) > 6 months post 
      implantation. RESULTS: Symptomatic responders had longer pre- (172.3 +/- 17.9 vs. 
      159.0 +/- 18.3 ms; p = 0.027) and postimplantation (157.2 +/- 24.1 vs. 136.7 +/- 23.2 
      ms; p = 0.009) QRS duration. Preimplantation QRS < 150 ms predicted poor response 
      (odds ratio [OR] for response vs. lack of response 0.04; 95% confidence interval 
      [CI] 0.001-0.74). Predictors of symptomatic response included: postimplantation 
      QRS > 160 ms (OR 7.2; 95% CI 1.24-41.94), longer QRS duration before (OR for a 1 
      ms increase 1.04, 95% CI 1.00-1.08) and post implantation (OR for a 1 ms increase 
      1.04; 95% CI 1.01-1.07). Area under the curve (AUC) for pre- and postimplantation 
      QRS duration was 0.672 (95% CI 0.51-0.84) and 0.727 (95% CI 0.57-0.89), 
      respectively, with cut-off points of 178.5 ms and 157 ms. For post implantation 
      QRS axis, AUC was 0.689 (95% CI 0.53-0.85), with cut-off points of -60.5 degrees  or 
      -38.5 degrees . Preimplantation QRS axis was the only predictor of echocardiographic 
      response (OR 0.98; 95% CI 0.96-1.00), with AUC of 0.693 (95% CI 0.54-0.85) and a 
      threshold of -36 degrees . CONCLUSIONS: Marked pre- and postimplantation QRS prolongation 
      and preimplantation negative QRS axis deviation are moderate predictors of 
      response to CRT.
FAU - Fabiszak, Tomasz
AU  - Fabiszak T
AD  - Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, 
      Collegium Medicum in Bydgoszcz, Poland. tfabiszak@cm.umk.pl.
FAU - Lach, Piotr
AU  - Lach P
AD  - Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, 
      Collegium Medicum in Bydgoszcz, Poland.
FAU - Ratajczak, Jakub
AU  - Ratajczak J
AD  - Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, 
      Collegium Medicum in Bydgoszcz, Poland.
FAU - Kozinski, Marek
AU  - Kozinski M
AD  - Department of Principles of Clinical Medicine, Nicolaus Copernicus University, 
      Collegium Medicum in Bydgoszcz, Poland.
FAU - Krupa, Wojciech
AU  - Krupa W
AD  - Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, 
      Collegium Medicum in Bydgoszcz, Poland.
FAU - Kubica, Jacek
AU  - Kubica J
AD  - Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, 
      Collegium Medicum in Bydgoszcz, Poland.
LA  - eng
PT  - Journal Article
DEP - 20181116
PL  - Poland
TA  - Cardiol J
JT  - Cardiology journal
JID - 101392712
SB  - IM
MH  - Bundle-Branch Block/therapy
MH  - *Cardiac Resynchronization Therapy
MH  - Electrocardiography
MH  - Female
MH  - *Heart Failure/therapy
MH  - Humans
MH  - Male
MH  - Retrospective Studies
MH  - Stroke Volume
MH  - Treatment Outcome
MH  - Ventricular Function, Left
PMC - PMC8078989
OTO - NOTNLM
OT  - QRS axis
OT  - cardiac resynchronization therapy
OT  - heart failure
OT  - left bundle branch block
COIS- Conflict of interest: None declared
EDAT- 2018/11/18 06:00
MHDA- 2021/08/18 06:00
PMCR- 2020/11/06
CRDT- 2018/11/17 06:00
PHST- 2018/07/18 00:00 [received]
PHST- 2018/10/31 00:00 [accepted]
PHST- 2018/10/22 00:00 [revised]
PHST- 2018/11/18 06:00 [pubmed]
PHST- 2021/08/18 06:00 [medline]
PHST- 2018/11/17 06:00 [entrez]
PHST- 2020/11/06 00:00 [pmc-release]
AID - VM/OJS/J/59340 [pii]
AID - cardj-27-5-575 [pii]
AID - 10.5603/CJ.a2018.0138 [doi]
PST - ppublish
SO  - Cardiol J. 2020;27(5):575-582. doi: 10.5603/CJ.a2018.0138. Epub 2018 Nov 16.