Non‐invasively quantified changes in left ventricular activation predict outcomes in patients undergoing cardiac resynchronization therapy.
Background: Changes in left ventricular (LV) activation after cardiac resynchronization therapy (CRT) influence survival but are difficult to quantify noninvasively. Methods and Results: We studied 527 CRT patients to assess whether noninvasive quantification of changes in LV activation, defined by...
| Published in: | Journal of Cardiovascular Electrophysiology Vol. 30; no. 11; pp. 2475 - 2484 |
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| Main Authors: | , , , , , , , , , , |
| Format: | research tables/charts Journal Article |
| Published: |
Wiley-Blackwell
Nov2019
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=139373372&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 139373372 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10453873 GSB jtl: Journal of Cardiovascular Electrophysiology issn: 10453873 maglogo: Y pubinfo: dt: Nov2019 vid: 30 iid: 11 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 139373372 139373372 139373372 10.1111/jce.14192 139373372 ppf: 2475 ppct: 9 formats: fmt: – @attributes: type: T – @attributes: type: C – @attributes: type: P tig: atl: Non‐invasively quantified changes in left ventricular activation predict outcomes in patients undergoing cardiac resynchronization therapy. aug: au: Friedman, Daniel J. Emerek, Kasper Hansen, Steen Møller Polcwiartek, Christoffer Sørensen, Peter L. Loring, Zak Sutter, Joanne Søgaard, Peter Kisslo, Joseph Graff, Claus Atwater, Brett D. affil: Electrophysiology Section, Duke University Hospital, Durham North Carolina sug: subj: Cardiac Resynchronization Therapy Heart Failure Surgery Heart Failure Prognosis Noninvasive Procedures Methods Postoperative Period Ventricular Function, Left Evaluation Human Treatment Outcomes QRS Complex Heart Transplantation Mortality Risk Factors Electrocardiography Vectorcardiography Kaplan-Meier Estimator Multivariate Analysis Cox Proportional Hazards Model Odds Ratio Confidence Intervals Survival ab: Background: Changes in left ventricular (LV) activation after cardiac resynchronization therapy (CRT) influence survival but are difficult to quantify noninvasively. Methods and Results: We studied 527 CRT patients to assess whether noninvasive quantification of changes in LV activation, defined by change (Δ) in QRS area (QRSA), can predict outcomes after CRT. The study outcome was time until LV assist device(LVAD), cardiac transplant, or death. The three‐dimensional QRSA was measured from clinical 12 lead ECGs which were transformed into vectorcardiograms using the Kors method. QRSA was calculated as (QRSx2 + QRSy2 + QRSz2)1/2; ΔQRSA was calculated as post‐QRSA minus pre‐QRSA, where a negative value represents a reduction in LV activation delay. Kaplan–Meier plots and multivariable Cox proportional hazards models were used to relate ΔQRSA area with outcomes after stratifying the population into quartiles of ΔQRSA. The median baseline QRSA of 93.6 µVs decreased to 59.7 µVs after CRT. Progressive reductions in QRSA with CRT were associated with a lower rate of LVAD, transplant, or death across patient quartiles (P < .001). In Cox regression analyses, ΔQRSA was associated with outcomes independent of QRS morphology and other clinical variables (Q1[greatest decrease] vs Q4[smallest change=reference], HR 0.45, CI, 0.30‐0.70, P < .001). There was no interaction between ΔQRSA and QRS morphology. Conclusions: CRT induced ΔQRSA was associated with clinically meaningful changes in event‐free survival. ΔQRSA may be a novel target to guide lead implantation and device optimization. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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