Horizontal QRS Axis Predicts Response to Cardiac Resynchronization Therapy in Heart Failure Patients with Left Bundle Branch Block.

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm Pub Date : 2024-11-11 DOI:10.1016/j.hrthm.2024.11.011

Zhisheng Chen, Jianmin Chu, Jing Wang, Chi Cai, Xilie Lu, Manshu Song, Lois Balmer, Wei Wang, Xuerui Tan

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引用次数: 0

Abstract

Background: Electrocardiogram criteria for left bundle branch block (LBBB) inadequately predict left ventricular electrical dyssynchrony, complicating cardiac resynchronization therapy (CRT) candidate selection.

Objective: To investigate the predictive value of the horizontal QRS axis for CRT response in heart failure (HF) patients with LBBB patterns.

Methods: The direction and magnitude of the horizontal QRS axis were calculated using the net amplitudes in leads V₂ and V₆. CRT response was defined as a ≥10% increase in left ventricular ejection fraction (LVEF) and at least one New York Heart Association (NYHA) class reduction one-year post-CRT implantation. The composite endpoint included HF hospitalization or all-cause mortality.

Results: Among 244 consecutive CRT recipients, 156 (63.9%) responded favorably, while 88 (36.1%) were non-responders. The horizontal QRS axis demonstrated significant backward deviation [-75.5° (-79.7°, -69.0°) vs. -65.0° (-73.0°, -46.5°), P <0.001] and larger magnitude (35.5±10.9 mm vs. 25.5±10.5 mm, P <0.001) in CRT responders compared to non-responders. The direction and magnitude independently predicted CRT response with an area under the curve (AUC) of 0.778 (95% CI: 0.717, 0.839) and 0.749 (95% CI: 0.685, 0.814), respectively. Combining both parameters increased the AUC to 0.814 (95% CI: 0.760, 0.868). Moreover, the direction and magnitude of the horizontal QRS axis, or their combination, predicted the composite endpoint of HF hospitalization or all-cause mortality, with hazard ratios (HR) of 0.36 (95% CI: 0.22, 0.60), 0.41 (95% CI: 0.25, 0.67), and 0.25 (95% CI: 0.15, 0.41), respectively.

Conclusion: Horizontal QRS axis accurately predicts CRT response and prognosis in HF patients with LBBB.

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水平 QRS 轴预测左束支传导阻滞的心力衰竭患者对心脏再同步化疗法的反应

背景：左束支传导阻滞（LBBB）的心电图标准不能充分预测左心室电不同步，从而使心脏再同步化治疗（CRT）候选者的选择变得复杂：研究水平 QRS 轴对具有 LBBB 模式的心力衰竭（HF）患者 CRT 反应的预测价值：方法：利用 V2 和 V6 导联的净振幅计算水平 QRS 轴的方向和幅度。CRT反应定义为植入CRT一年后左室射血分数（LVEF）增加≥10%，纽约心脏协会（NYHA）分级至少降低一级。复合终点包括房颤住院或全因死亡率：在连续接受 CRT 治疗的 244 人中，156 人（63.9%）反应良好，88 人（36.1%）无反应。水平 QRS 轴显示出显著的后向偏差[-75.5° (-79.7°, -69.0°) vs. -65.0° (-73.0°, -46.5°), P 结论：水平 QRS 轴可准确预测心律失常的发生率：水平 QRS 轴可准确预测 LBBB HF 患者的 CRT 反应和预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Heart rhythm 医学-心血管系统

CiteScore

10.50

自引率

5.50%

发文量

1465

审稿时长

24 days

期刊介绍： HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability. HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community. The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.