Clinical utility of QRS duration normalized to left ventricular volume for predicting cardiac resynchronization therapy efficacy in patients with "mid-range" QRS duration

Nobuhiko Yamamoto; Takashi Noda; Makoto Nakano; Tomohiro Ito; Hiroyuki Sato; Hideka Hayashi; Takahiko Chiba; Yuhi Hasebe; Nobuhiko Ueda; Tsukasa Kamakura; Kohei Ishibashi; Satoshi Miyata; Kengo Kusano; Satoshi Yasuda

doi:10.1016/j.hrthm.2024.02.019

Clinical utility of QRS duration normalized to left ventricular volume for predicting cardiac resynchronization therapy efficacy in patients with "mid-range" QRS duration

Heart Rhythm. 2024 Feb 15:S1547-5271(24)00190-5. doi: 10.1016/j.hrthm.2024.02.019. Online ahead of print.

Authors

Affiliations

¹ Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
² Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
³ Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
⁴ Teikyo University Graduate School of Public Health, Tokyo, Japan.
⁵ Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan. Electronic address: syasuda@cardio.med.tohoku.ac.jp.

PMID: 38367890
DOI: 10.1016/j.hrthm.2024.02.019

Abstract

Background: Cardiac resynchronization therapy (CRT) is effective for patients with heart failure with QRS duration (QRSd) ≥150 ms. However, its beneficial effect seems to be limited for those with "mid-range" QRSd (120-149 ms). Recent studies have demonstrated that modifying QRSd to left ventricular end-diastolic volume (LVEDV)-modified QRSd-improves the prediction of clinical outcomes of CRT.

Objective: The purpose of this study was to investigate the clinical impact of the modified QRSd on the efficacy of CRT in patients with "mid-range" QRSd.

Methods: We conducted a retrospective, multicenter, observational study, with heart failure hospitalization (HFH) after CRT as the primary endpoint. Modified QRSd is defined as QRSd divided by LVEDV, determined through the Teichholtz method of echocardiography.

Results: Among the 506 consecutive patients considered, 119 (mean age 61 ± 15 years; 80% male, QRSd 135 ± 9 ms) with a "mid-range" QRSd who underwent de novo CRT device implantation were included for analysis. During median follow-up of 878 days [interquartile range 381-1663 days], HFH occurred in 45 patients (37%). Fine-Gray analysis revealed modified QRSd was an independent predictor of HFH (hazard ratio [HR] 0.97; 95% confidence interval [CI] 0.96-0.99; P <.01). Receiver operating characteristic curve analysis revealed a cutoff value of 0.65 ms/mL for the modified QRSd in predicting HFH. Patients above the threshold exhibited a significantly lower incidence of HFH than patients below the threshold (HR 0.46; 95% CI 0.25-0.86; P = .01).

Conclusion: Modified QRSd can effectively predict the efficacy of CRT in patients with a "mid-range" QRSd.

Keywords: Cardiac resynchronization therapy; Heart failure; Left ventricular reverse remodeling; Left ventricular volume; Modified QRS duration; “Mid-range” QRS duration.