Comparison of Efficacy of Reverse Remodeling and Clinical Improvement for Relatively Narrow and Wide QRS Complexes After Cardiac Resynchronization Therapy for Heart Failure

Authors

  • CHEUK-MAN YU M.D.,

    1. Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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  • JEFFREY WING-HONG FUNG M.R.C.P.,

    1. Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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  • CHI-KIN CHAN M.R.C.P.,

    1. Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong
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  • YAT-SUN CHAN M.R.C.P.,

    1. Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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  • QING ZHANG B.M., M.M.,

    1. Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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  • HONG LIN B.M., M.M.,

    1. Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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  • GABRIEL W.K. YIP M.R.C.P.,

    1. Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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  • LEO C.C. KUM M.R.C.P.,

    1. Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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  • SHUN-LING KONG B.N., M.N.,

    1. Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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  • YAN ZHANG B.M.,

    1. Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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  • JOHN E. SANDERSON M.D.

    1. Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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  • Manuscript received 23 November 2003; Accepted for publication 27 February 2004.

Address for correspondence: Cheuk-Man Yu, M.D., Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong. Fax: 852-2637-3852; E-mail: cmyu@cuhk.edu.hk

Abstract

Introduction: Cardiac resynchronization therapy (CRT) has been shown to reverse left ventricular (LV) remodeling and improve symptoms in heart failure patients with wide QRS complexes; however, its role in patients with mildly prolonged QRS complexes is unclear. This study investigated if CRT benefited patients with mildly prolonged QRS complexes >120 to 150 ms and explored if the severity of systolic asynchrony determined such a response.

Methods and Results: Fifty-eight patients (age 66 ± 11 years, 66% male) who had undergone CRT were studied prospectively. Of these patients, 27 had QRS duration between 120 and 150 ms (group A), and 31 had QRS duration >150 ms (group B). Tissue Doppler echocardiography and clinical assessment were performed at baseline and 3 months after CRT. Both groups had significant reduction of LV volume and increased ejection fraction, +dP/dt, and sphericity index (all P < 0.05). These improvements were greater in group B and were explained by the higher prevalence of systolic intraventricular asynchrony. Significant reverse remodeling (reduction of LV end-systolic volume >15%) was evident in 46% of group A patients and 68% of group B patients. Improvement in clinical endpoints was observed in both groups (all P < 0.01), although the changes in metabolic equivalent and New York Heart Association functional class were greater in group B. In both groups, systolic asynchrony index (TS-SD) was the most important predictor of reverse remodeling (r =−0.78, P < 0.001) and was the only independent predictor in the multivariate model (β=−1.80, confidence interval =−2.18 to −1.42, P < 0.001); QRS duration was not. A predefined TS-SD value >32.6 ms had a sensitivity of 94% and specificity of 83% to predict reverse remodeling. Improvement of intraventricular asynchrony after CRT was evident only in responders (P = 0.01).

Conclusion: Improvement of LV remodeling and clinical status is evident after CRT in heart failure patients with QRS duration >120 to 150 ms. These responders are closely predicted by the severity of prepacing intraventricular asynchrony but not QRS duration.

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