European Heart Journal Advance Access originally published online on February 23, 2005
European Heart Journal 2005 26(11):1094-1100; doi:10.1093/eurheartj/ehi146
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Clinical and electrocardiographic predictors of a positive response to cardiac resynchronization therapy in advanced heart failure
1Department of Cardiology, Centre Hospitalier Universitaire, Rennes F-35000, France
2Department of Public Health, Centre Hospitalier Universitaire, Rennes F-35000, France
Received 20 August 2004; revised 21 December 2004; accepted 29 December 2004; online publish-ahead-of-print 23 February 2005.
* Corresponding author. Tel: +33 2 99 28 25 25; fax: +33 2 99 28 25 10; E-mail address: jean-claude.daubert{at}chu-rennes.fr
See page 1054 for the editorial comment on this article (doi:10.1093/eurheartj/ehi246)
Aims Cardiac resynchronization therapy (CRT) is an effective treatment for refractory congestive heart failure (CHF). However, up to 30% of patients do not respond to CRT. The aim of this study was to identify clinical and electrocardiographic (ECG) predictors of a positive response to CRT.
Methods and results This retrospective study included 139 consecutive patients successfully implanted with a CRT device (mean age, 68±9 years, 113 men). At baseline, 69% of patients were in New York Heart Association (NYHA) functional class III, and 31% in class IV, mean left ventricular ejection fraction was 21±6%, and mean QRS duration was 188±28 ms. In each patient, left and right ventricular leads were placed to attain the shortest QRS duration during biventricular stimulation. Patients were classified at 6 months as responders to CRT (n=100) if they were alive, they had not been re-hospitalized for management of CHF, and the NYHA class had decreased by 1 point, and/or peak VO2 or 6 min hall-walk increased by >10%. All others were classified as non-responders (n=38; one patient was lost to follow-up). Uni- and multivariate logistic regression analyses were performed to detect a pre- or intra-operative predictor of a positive response to CRT. Among multiple demographic, clinical, and ECG variables, the amount of QRS shortening (
QRS) associated with biventricular stimulation was the only independent predictor of a positive (37±23 ms) vs. negative (11±23 ms) response to CRT (P<0.001).
Conclusion A positive response to CRT was observed in 73% of patients at 6 months and predicted only by QRS.
Key Words: Cardiac resynchronization therapy • Biventricular pacing • Heart failure • Prognostic factors
CiteULike 
Connotea 
Del.icio.us What's this?
Related articles in EHJ:
- How to predict response to cardiac resynchronization therapy?
- Jeroen J. Bax and Martin J. Schalij
EHJ 2005 26: 1054-1055.[Extract] [Full Text]
This article has been cited by other articles:
|
|
 |
|
  M. Haghjoo, A. Bagherzadeh, M. M. Farahani, Z. O. Haghighi, and M. A. Sadr-Ameli Significance of QRS morphology in determining the prevalence of mechanical dyssynchrony in heart failure patients eligible for cardiac resynchronization: particular focus on patients with right bundle branch block with and without coexistent left-sided conduction defects Europace, May 1, 2008; 10(5): 566 - 571. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C Leclercq Importance of concordance between left ventricular pacing sites and latest activated regions: myth or reality? Heart, October 1, 2007; 93(10): 1170 - 1172. [Full Text] [PDF]
|
|
|
|
|
|
M. Becker, A. Franke, O. A Breithardt, C. Ocklenburg, T. Kaminski, R. Kramann, C. Knackstedt, C. Stellbrink, P. Hanrath, P. Schauerte, et al. Impact of left ventricular lead position on the efficacy of cardiac resynchronisation therapy: a two-dimensional strain echocardiography study Heart, October 1, 2007; 93(10): 1197 - 1203. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Lenarczyk, O. Kowalski, T. Kukulski, M. Szulik, P. Pruszkowska-Skrzep, T. Zielinska, J. Kowalczyk, S. Pluta, A. Duszanska, B. Sredniawa, et al. Triple-site biventricular pacing in patients undergoing cardiac resynchronization therapy: a feasibility study Europace, September 1, 2007; 9(9): 762 - 767. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. A. McAlister, J. Ezekowitz, N. Hooton, B. Vandermeer, C. Spooner, D. M. Dryden, R. L. Page, M. A. Hlatky, and B. H. Rowe Cardiac Resynchronization Therapy for Patients With Left Ventricular Systolic Dysfunction: A Systematic Review JAMA, June 13, 2007; 297(22): 2502 - 2514. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Schmidt, J. Frielingsdorf, M. Debrunner, R. Tavakoli, M. Genoni, E. Straumann, O. Bertel, and B. Naegeli Acute biventricular pacing after cardiac surgery has no influence on regional and global left ventricular systolic function Europace, June 1, 2007; 9(6): 432 - 436. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Becker, R. Kramann, A. Franke, O.-A. Breithardt, N. Heussen, C. Knackstedt, C. Stellbrink, P. Schauerte, M. Kelm, and R. Hoffmann Impact of left ventricular lead position in cardiac resynchronization therapy on left ventricular remodelling. A circumferential strain analysis based on 2D echocardiography Eur. Heart J., May 2, 2007; 28(10): 1211 - 1220. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Macias, I. Garcia-Bolao, E. Diaz-Infante, J. M. Tolosana, B. Vidal, J. J. Gavira, A. Berruezo, J. Brugada, and L. Mont Cardiac resynchronization therapy: predictive factors of unsuccessful left ventricular lead implant Eur. Heart J., February 2, 2007; 28(4): 450 - 456. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. P. Badano, O. Gaddi, C. Peraldo, G. Lupi, M. Sitges, F. Parthenakis, S. Molteni, M. R. Pagliuca, B. Sassone, P. Di Stefano, et al. Left ventricular electromechanical delay in patients with heart failure and normal QRS duration and in patients with right and left bundle branch block Europace, January 1, 2007; 9(1): 41 - 47. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Thompson, G. Saab, D. Birnie, B. J.W. Chow, H. Ukkonen, K. Ananthasubramaniam, R. A. deKemp, L. Garrard, T. D. Ruddy, J. N. DaSilva, et al. Is Septal Glucose Metabolism Altered in Patients with Left Bundle Branch Block and Ischemic Cardiomyopathy? J. Nucl. Med., November 1, 2006; 47(11): 1763 - 1768. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. M. Hawkins, M. C. Petrie, M. R. MacDonald, K. J. Hogg, and J. J.V. McMurray Selecting patients for cardiac resynchronization therapy: electrical or mechanical dyssynchrony? Eur. Heart J., June 1, 2006; 27(11): 1270 - 1281. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Stern Electrocardiogram: Still the Cardiologist's Best Friend Circulation, May 16, 2006; 113(19): e753 - e756. [Full Text] [PDF]
|
|
|
|
|
|
E. Donal, C. Leclercq, C. Linde, and J.-C. Daubert Effects of cardiac resynchronization therapy on disease progression in chronic heart failure Eur. Heart J., May 1, 2006; 27(9): 1018 - 1025. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. J. Bax, T. Abraham, S. S. Barold, O. A. Breithardt, J. W.H. Fung, S. Garrigue, J. Gorcsan III, D. L. Hayes, D. A. Kass, J. Knuuti, et al. Cardiac Resynchronization Therapy: Part 1--Issues Before Device Implantation J. Am. Coll. Cardiol., December 20, 2005; 46(12): 2153 - 2167. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Predicting Response to CRT Journal Watch Cardiology, June 24, 2005; 2005(624): 3 - 3. [Full Text]
|
|
|
|
|
|
J. J. Bax and M. J. Schalij How to predict response to cardiac resynchronization therapy? Eur. Heart J., June 1, 2005; 26(11): 1054 - 1055. [Full Text] [PDF]
|
|