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European Heart Journal Advance Access published online on February 23, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi146
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved

Clinical research

Clinical and electrocardiographic predictors of a positive response to cardiac resynchronization therapy in advanced heart failure

Guillaume Lecoq 1, Christophe Leclercq 1, Emmanuelle Leray 2, Christophe Crocq 1, Christine Alonso 1, Christian de Place 1, Philippe Mabo 1, and Claude Daubert 1*

1 Department of Cardiology, Centre Hospitalier Universitaire, Rennes F-35000, France
2 Department of Public Health, Centre Hospitalier Universitaire, Rennes F-35000, France

* To whom correspondence should be addressed.
Claude Daubert, E-mail: jean-claude.daubert{at}chu-rennes.fr


  Abstract

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 ({Delta}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 {Delta}QRS.

Keywords: Cardiac resynchronization therapy; Biventricular pacing; Heart failure; Prognostic factors.
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