TY - JOUR
T1 - Novel measure of electrical dyssynchrony predicts response in cardiac resynchronization therapy
T2 - Results from the SMART-AV Trial
AU - Tereshchenko, Larisa G.
AU - Cheng, Alan
AU - Park, Jason
AU - Wold, Nicholas
AU - Meyer, Timothy E.
AU - Gold, Michael R.
AU - Mittal, Suneet
AU - Singh, Jagmeet
AU - Stein, Kenneth M.
AU - Ellenbogen, Kenneth A.
N1 - Funding Information:
We thank Fabio Badilini, PhD, and his team for providing AMPS ECGScan software for digitizing electrocardiograms. We also thank undergraduate students of the Johns Hopkins University (Albert Feeny, Kutay Muslu, Kavya Singampalli, Patrick Jongeneel, Valeriya Aranovich, Akudo Ogubunka, and Malvi Hemani) for help with digitizing electro-cardiograms.
Publisher Copyright:
© 2015 Heart Rhythm Society.
PY - 2015/12/1
Y1 - 2015/12/1
N2 - Background Cardiac resynchronization therapy (CRT) reduces mortality and morbidity in selected heart failure patients. However, not all patients respond to CRT. Objective We hypothesized that a novel measure of electrical dyssynchrony, sum absolute QRST integral (SAI QRST), predicts CRT response independent of QRS duration and morphology. Methods We retrospectively analyzed baseline 12-lead electrocardiograms of SmartDelay Determined AV Optimization: A comparison to other AV delay methods used in cardiac resynchronization therapy (SMART-AV) trial study participants (N = 234; mean age 67 years; 163 (70%) men; 140 (60%) ischemic cardiomyopathy; mean left ventricular ejection fraction 25%; mean QRS duration 152 ms; 179 (77%) had left bundle branch block). Baseline pre-implant electrocardiograms were digitized, transformed into orthogonal XYZ, and analyzed automatically by customized MATLAB software. SAI QRST was measured as an averaged arithmetic sum of absolute areas under the QRST curve. Patients were followed prospectively 6 months after CRT-defibrillator implantation. Patients with a decrease in left ventricular end-systolic volume ≥15 mL after 6 months of CRT were considered responders. The logistic regression model was adjusted for age, sex, bundle branch block morphology, left ventricular ejection fraction, cardiomyopathy type, and QRS duration. Results Patients with the high mean SAI QRST (third tertile) had 2.5 times greater odds of response than those with the low mean SAI QRST (first tertile: odds ratio [OR] 2.5; 95% confidence interval [CI] 1.3-5.0; P =.010) and 1.9 times greater than the lower 2 tertiles combined (OR 1.9; 95% CI 1.1-3.5; P =.03). Adjustment for renal function (OR 2.33; 95% CI 1.32-4.11; P =.003) and left ventricular lead position in right anterior oblique and left anterior oblique views (OR 1.7; 95% CI 0.9-3.2; P =.087) did not attenuate association of SAI QRST with outcome. Conclusion High SAI QRST independently predicts CRT response in the SMART-AV study.
AB - Background Cardiac resynchronization therapy (CRT) reduces mortality and morbidity in selected heart failure patients. However, not all patients respond to CRT. Objective We hypothesized that a novel measure of electrical dyssynchrony, sum absolute QRST integral (SAI QRST), predicts CRT response independent of QRS duration and morphology. Methods We retrospectively analyzed baseline 12-lead electrocardiograms of SmartDelay Determined AV Optimization: A comparison to other AV delay methods used in cardiac resynchronization therapy (SMART-AV) trial study participants (N = 234; mean age 67 years; 163 (70%) men; 140 (60%) ischemic cardiomyopathy; mean left ventricular ejection fraction 25%; mean QRS duration 152 ms; 179 (77%) had left bundle branch block). Baseline pre-implant electrocardiograms were digitized, transformed into orthogonal XYZ, and analyzed automatically by customized MATLAB software. SAI QRST was measured as an averaged arithmetic sum of absolute areas under the QRST curve. Patients were followed prospectively 6 months after CRT-defibrillator implantation. Patients with a decrease in left ventricular end-systolic volume ≥15 mL after 6 months of CRT were considered responders. The logistic regression model was adjusted for age, sex, bundle branch block morphology, left ventricular ejection fraction, cardiomyopathy type, and QRS duration. Results Patients with the high mean SAI QRST (third tertile) had 2.5 times greater odds of response than those with the low mean SAI QRST (first tertile: odds ratio [OR] 2.5; 95% confidence interval [CI] 1.3-5.0; P =.010) and 1.9 times greater than the lower 2 tertiles combined (OR 1.9; 95% CI 1.1-3.5; P =.03). Adjustment for renal function (OR 2.33; 95% CI 1.32-4.11; P =.003) and left ventricular lead position in right anterior oblique and left anterior oblique views (OR 1.7; 95% CI 0.9-3.2; P =.087) did not attenuate association of SAI QRST with outcome. Conclusion High SAI QRST independently predicts CRT response in the SMART-AV study.
KW - Cardiac resynchronization therapy
KW - Heart failure
KW - Remodeling
KW - SAI QRST
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U2 - 10.1016/j.hrthm.2015.08.009
DO - 10.1016/j.hrthm.2015.08.009
M3 - Article
C2 - 26272523
AN - SCOPUS:84958587025
SN - 1547-5271
VL - 12
SP - 2402
EP - 2410
JO - Heart Rhythm
JF - Heart Rhythm
IS - 12
ER -