Cardiac resynchronization therapy improves myocardial conduction

Mei Yang, Xuping Li, Dachun Yang, Yigang Li, Shenghua Zhou, Jinjun Liang, Gang Wu, Freddy Del-Carpio Munoz, Horng Haur Chen, Paul Andrew Friedman, Yong-Mei Cha

Research output: Contribution to journalArticle

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Abstract

Background: Cardiac resynchronization therapy (CRT) reverses left ventricular remodeling and improves left ventricular systolic function. However, little is known about whether CRT improves ventricular conduction. Objective: To determine the relationship between CRT response and QRS narrowing. Methods: The study included consecutive patients who underwent CRT with defibrillator (CRT-D) implantation between January 2002 and December 2012 and had subsequent generator replacement (GR). At the time of GR, super-responder was defined as those who had left ventricular ejection fraction (LVEF) of 50% or more; patients who had an LVEF of 36–49% with an increase of more than 5% were considered responders, and the others were nonresponders. All patients were assessed 6 months after CRT-D implantation and at the time of GR. Results: Of 114 study patients, 58 (50.9%) were nonresponders, 29 (25.4%) responders, and 27 (23.7%) super-responders. QRS narrowing at 6 months was significant in super-responders (175.4 ± 21.4 to 159.7 ± 20.7 ms, P = 0.001) and responders (169.0 ± 21.3 to 157.7 ± 17.6 ms, P = 0.008). At time of GR, only super-responders had further QRS narrowing (159.7 ± 20.7 to 146.3 ± 19.2 ms, P < 0.001). QRS duration change after 6 months was independently associated with super-response (hazard ratio: 1.20 for every 5 ms QRS duration narrowing; 95% confidence interval, 1.06–1.38; P = 0.005), and QRS narrowing of 10 ms or more was associated with lower risk of all-cause mortality after GR. Conclusion: Continuous QRS narrowing after CRT, as an electrical marker, is associated with a super-response to CRT. Further QRS narrowing 6 months after CRT implantation was associated with lower risk of mortality after GR.

Original languageEnglish (US)
JournalPACE - Pacing and Clinical Electrophysiology
DOIs
StateAccepted/In press - Jan 1 2018

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Cardiac Resynchronization Therapy
Stroke Volume
Ventricular Remodeling
Defibrillators
Mortality
Left Ventricular Function
Confidence Intervals

Keywords

  • cardiac resynchronization therapy
  • generator replacement
  • QRS narrowing
  • super-response

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Cardiac resynchronization therapy improves myocardial conduction. / Yang, Mei; Li, Xuping; Yang, Dachun; Li, Yigang; Zhou, Shenghua; Liang, Jinjun; Wu, Gang; Del-Carpio Munoz, Freddy; Chen, Horng Haur; Friedman, Paul Andrew; Cha, Yong-Mei.

In: PACE - Pacing and Clinical Electrophysiology, 01.01.2018.

Research output: Contribution to journalArticle

Yang, Mei ; Li, Xuping ; Yang, Dachun ; Li, Yigang ; Zhou, Shenghua ; Liang, Jinjun ; Wu, Gang ; Del-Carpio Munoz, Freddy ; Chen, Horng Haur ; Friedman, Paul Andrew ; Cha, Yong-Mei. / Cardiac resynchronization therapy improves myocardial conduction. In: PACE - Pacing and Clinical Electrophysiology. 2018.
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abstract = "Background: Cardiac resynchronization therapy (CRT) reverses left ventricular remodeling and improves left ventricular systolic function. However, little is known about whether CRT improves ventricular conduction. Objective: To determine the relationship between CRT response and QRS narrowing. Methods: The study included consecutive patients who underwent CRT with defibrillator (CRT-D) implantation between January 2002 and December 2012 and had subsequent generator replacement (GR). At the time of GR, super-responder was defined as those who had left ventricular ejection fraction (LVEF) of 50{\%} or more; patients who had an LVEF of 36–49{\%} with an increase of more than 5{\%} were considered responders, and the others were nonresponders. All patients were assessed 6 months after CRT-D implantation and at the time of GR. Results: Of 114 study patients, 58 (50.9{\%}) were nonresponders, 29 (25.4{\%}) responders, and 27 (23.7{\%}) super-responders. QRS narrowing at 6 months was significant in super-responders (175.4 ± 21.4 to 159.7 ± 20.7 ms, P = 0.001) and responders (169.0 ± 21.3 to 157.7 ± 17.6 ms, P = 0.008). At time of GR, only super-responders had further QRS narrowing (159.7 ± 20.7 to 146.3 ± 19.2 ms, P < 0.001). QRS duration change after 6 months was independently associated with super-response (hazard ratio: 1.20 for every 5 ms QRS duration narrowing; 95{\%} confidence interval, 1.06–1.38; P = 0.005), and QRS narrowing of 10 ms or more was associated with lower risk of all-cause mortality after GR. Conclusion: Continuous QRS narrowing after CRT, as an electrical marker, is associated with a super-response to CRT. Further QRS narrowing 6 months after CRT implantation was associated with lower risk of mortality after GR.",
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AU - Yang, Mei

AU - Li, Xuping

AU - Yang, Dachun

AU - Li, Yigang

AU - Zhou, Shenghua

AU - Liang, Jinjun

AU - Wu, Gang

AU - Del-Carpio Munoz, Freddy

AU - Chen, Horng Haur

AU - Friedman, Paul Andrew

AU - Cha, Yong-Mei

PY - 2018/1/1

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N2 - Background: Cardiac resynchronization therapy (CRT) reverses left ventricular remodeling and improves left ventricular systolic function. However, little is known about whether CRT improves ventricular conduction. Objective: To determine the relationship between CRT response and QRS narrowing. Methods: The study included consecutive patients who underwent CRT with defibrillator (CRT-D) implantation between January 2002 and December 2012 and had subsequent generator replacement (GR). At the time of GR, super-responder was defined as those who had left ventricular ejection fraction (LVEF) of 50% or more; patients who had an LVEF of 36–49% with an increase of more than 5% were considered responders, and the others were nonresponders. All patients were assessed 6 months after CRT-D implantation and at the time of GR. Results: Of 114 study patients, 58 (50.9%) were nonresponders, 29 (25.4%) responders, and 27 (23.7%) super-responders. QRS narrowing at 6 months was significant in super-responders (175.4 ± 21.4 to 159.7 ± 20.7 ms, P = 0.001) and responders (169.0 ± 21.3 to 157.7 ± 17.6 ms, P = 0.008). At time of GR, only super-responders had further QRS narrowing (159.7 ± 20.7 to 146.3 ± 19.2 ms, P < 0.001). QRS duration change after 6 months was independently associated with super-response (hazard ratio: 1.20 for every 5 ms QRS duration narrowing; 95% confidence interval, 1.06–1.38; P = 0.005), and QRS narrowing of 10 ms or more was associated with lower risk of all-cause mortality after GR. Conclusion: Continuous QRS narrowing after CRT, as an electrical marker, is associated with a super-response to CRT. Further QRS narrowing 6 months after CRT implantation was associated with lower risk of mortality after GR.

AB - Background: Cardiac resynchronization therapy (CRT) reverses left ventricular remodeling and improves left ventricular systolic function. However, little is known about whether CRT improves ventricular conduction. Objective: To determine the relationship between CRT response and QRS narrowing. Methods: The study included consecutive patients who underwent CRT with defibrillator (CRT-D) implantation between January 2002 and December 2012 and had subsequent generator replacement (GR). At the time of GR, super-responder was defined as those who had left ventricular ejection fraction (LVEF) of 50% or more; patients who had an LVEF of 36–49% with an increase of more than 5% were considered responders, and the others were nonresponders. All patients were assessed 6 months after CRT-D implantation and at the time of GR. Results: Of 114 study patients, 58 (50.9%) were nonresponders, 29 (25.4%) responders, and 27 (23.7%) super-responders. QRS narrowing at 6 months was significant in super-responders (175.4 ± 21.4 to 159.7 ± 20.7 ms, P = 0.001) and responders (169.0 ± 21.3 to 157.7 ± 17.6 ms, P = 0.008). At time of GR, only super-responders had further QRS narrowing (159.7 ± 20.7 to 146.3 ± 19.2 ms, P < 0.001). QRS duration change after 6 months was independently associated with super-response (hazard ratio: 1.20 for every 5 ms QRS duration narrowing; 95% confidence interval, 1.06–1.38; P = 0.005), and QRS narrowing of 10 ms or more was associated with lower risk of all-cause mortality after GR. Conclusion: Continuous QRS narrowing after CRT, as an electrical marker, is associated with a super-response to CRT. Further QRS narrowing 6 months after CRT implantation was associated with lower risk of mortality after GR.

KW - cardiac resynchronization therapy

KW - generator replacement

KW - QRS narrowing

KW - super-response

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