Very Long-Term Follow-Up in Cardiac Resynchronization Therapy: Wider Paced QRS Equals Worse Prognosis

Background: Different electrocardiogram (ECG) findings are known to be independent predictors of clinical response to cardiac resynchronization therapy (CRT). It remains unknown how these findings influence very long-term prognosis. Methods and Results: A total of 102 consecutive patients (75 males,...

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Autores principales:	Patrick Leitz, Julia Köbe, Benjamin Rath, Florian Reinke, Gerrit Frommeyer, Christian Andresen, Fatih Güner, Julian Wolfes, Philipp S. Lange, Christian Ellermann, Lars Eckardt, Dirk G. Dechering
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	cardiac resynchronization heart failure very long-term follow-up ECG pacing Medicine R
Acceso en línea:	https://doaj.org/article/cf4f1d425bea48c09ba0b49beceffdb2
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spelling	oai:doaj.org-article:cf4f1d425bea48c09ba0b49beceffdb22021-11-25T18:07:48ZVery Long-Term Follow-Up in Cardiac Resynchronization Therapy: Wider Paced QRS Equals Worse Prognosis10.3390/jpm111111762075-4426https://doaj.org/article/cf4f1d425bea48c09ba0b49beceffdb22021-11-01T00:00:00Zhttps://www.mdpi.com/2075-4426/11/11/1176https://doaj.org/toc/2075-4426Background: Different electrocardiogram (ECG) findings are known to be independent predictors of clinical response to cardiac resynchronization therapy (CRT). It remains unknown how these findings influence very long-term prognosis. Methods and Results: A total of 102 consecutive patients (75 males, mean age 65 ± 10 years) referred to our center for CRT implantation had previously been included in this prospective observational study. The same patient group was now re-evaluated for death from all causes over a prolonged median follow-up of 10.3 years (interquartile range 9.4–12.5 years). During follow-up, 55 patients died, and 82% of the clinical non-responders (<i>n</i> = 23) and 44% of the responders (<i>n</i> = 79) were deceased. We screened for univariate associations and found QRS width during biventricular (BIV) pacing (<i>p</i> = 0.02), left ventricular (LV) pacing (<i>p</i> < 0.01), Δ LV paced–right ventricular (RV) paced (<i>p</i> = 0.03), age (<i>p</i> = 0.03), New York Heart Association (NYHA) class (<i>p</i> < 0.01), CHA<sub>2</sub>DS<sub>2</sub>-Vasc score (<i>p</i> < 0.01), glomerular filtration rate (<i>p</i> < 0.01), coronary artery disease (<i>p</i> < 0.01), non-ischemic cardiomyopathy (NICM) (<i>p</i> = 0.01), arterial hypertension (<i>p</i> < 0.01), NT-proBNP (<i>p</i> < 0.01), and clinical response to CRT (<i>p</i> < 0.01) to be significantly associated with mortality. In the multivariate analysis, NICM, the lower NYHA class, and smaller QRS width during BIV pacing were independent predictors of better outcomes. Conclusion: Our data show that QRS width duration during biventricular pacing, an ECG parameter easily obtainable during LV lead placement, is an independent predictor of mortality in a long-term follow-up. Our data add further evidence that NICM and lower NYHA class are independent predictors for better outcome after CRT implantation.Patrick LeitzJulia KöbeBenjamin RathFlorian ReinkeGerrit FrommeyerChristian AndresenFatih GünerJulian WolfesPhilipp S. LangeChristian EllermannLars EckardtDirk G. DecheringMDPI AGarticlecardiac resynchronizationheart failurevery long-term follow-upECGpacingMedicineRENJournal of Personalized Medicine, Vol 11, Iss 1176, p 1176 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	cardiac resynchronization heart failure very long-term follow-up ECG pacing Medicine R
spellingShingle	cardiac resynchronization heart failure very long-term follow-up ECG pacing Medicine R Patrick Leitz Julia Köbe Benjamin Rath Florian Reinke Gerrit Frommeyer Christian Andresen Fatih Güner Julian Wolfes Philipp S. Lange Christian Ellermann Lars Eckardt Dirk G. Dechering Very Long-Term Follow-Up in Cardiac Resynchronization Therapy: Wider Paced QRS Equals Worse Prognosis
description	Background: Different electrocardiogram (ECG) findings are known to be independent predictors of clinical response to cardiac resynchronization therapy (CRT). It remains unknown how these findings influence very long-term prognosis. Methods and Results: A total of 102 consecutive patients (75 males, mean age 65 ± 10 years) referred to our center for CRT implantation had previously been included in this prospective observational study. The same patient group was now re-evaluated for death from all causes over a prolonged median follow-up of 10.3 years (interquartile range 9.4–12.5 years). During follow-up, 55 patients died, and 82% of the clinical non-responders (<i>n</i> = 23) and 44% of the responders (<i>n</i> = 79) were deceased. We screened for univariate associations and found QRS width during biventricular (BIV) pacing (<i>p</i> = 0.02), left ventricular (LV) pacing (<i>p</i> < 0.01), Δ LV paced–right ventricular (RV) paced (<i>p</i> = 0.03), age (<i>p</i> = 0.03), New York Heart Association (NYHA) class (<i>p</i> < 0.01), CHA<sub>2</sub>DS<sub>2</sub>-Vasc score (<i>p</i> < 0.01), glomerular filtration rate (<i>p</i> < 0.01), coronary artery disease (<i>p</i> < 0.01), non-ischemic cardiomyopathy (NICM) (<i>p</i> = 0.01), arterial hypertension (<i>p</i> < 0.01), NT-proBNP (<i>p</i> < 0.01), and clinical response to CRT (<i>p</i> < 0.01) to be significantly associated with mortality. In the multivariate analysis, NICM, the lower NYHA class, and smaller QRS width during BIV pacing were independent predictors of better outcomes. Conclusion: Our data show that QRS width duration during biventricular pacing, an ECG parameter easily obtainable during LV lead placement, is an independent predictor of mortality in a long-term follow-up. Our data add further evidence that NICM and lower NYHA class are independent predictors for better outcome after CRT implantation.
format	article
author	Patrick Leitz Julia Köbe Benjamin Rath Florian Reinke Gerrit Frommeyer Christian Andresen Fatih Güner Julian Wolfes Philipp S. Lange Christian Ellermann Lars Eckardt Dirk G. Dechering
author_facet	Patrick Leitz Julia Köbe Benjamin Rath Florian Reinke Gerrit Frommeyer Christian Andresen Fatih Güner Julian Wolfes Philipp S. Lange Christian Ellermann Lars Eckardt Dirk G. Dechering
author_sort	Patrick Leitz
title	Very Long-Term Follow-Up in Cardiac Resynchronization Therapy: Wider Paced QRS Equals Worse Prognosis
title_short	Very Long-Term Follow-Up in Cardiac Resynchronization Therapy: Wider Paced QRS Equals Worse Prognosis
title_full	Very Long-Term Follow-Up in Cardiac Resynchronization Therapy: Wider Paced QRS Equals Worse Prognosis
title_fullStr	Very Long-Term Follow-Up in Cardiac Resynchronization Therapy: Wider Paced QRS Equals Worse Prognosis
title_full_unstemmed	Very Long-Term Follow-Up in Cardiac Resynchronization Therapy: Wider Paced QRS Equals Worse Prognosis
title_sort	very long-term follow-up in cardiac resynchronization therapy: wider paced qrs equals worse prognosis
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/cf4f1d425bea48c09ba0b49beceffdb2
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Very Long-Term Follow-Up in Cardiac Resynchronization Therapy: Wider Paced QRS Equals Worse Prognosis

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