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Could QRS duration adjusted to BMI and BSA predict Cardiac Resynchronization Therapy response?
Session:
CO 23 - Dispositivos
Speaker:
Beatriz Valente Silva
Congress:
CPC 2021
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.3 Cardiac Resynchronization Therapy
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Beatriz Silva ; Tiago Rodrigues; Nelson Cunha; Pedro Silvério António; Sara Couto Pereira; Pedro Alves da Silva; Joana Brito; Margarida Martins; Catarina Oliveira; Beatriz Garcia; Afonso Ferreira; Fausto J.Pinto; João de Sousa; Pedro Marques
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Current Guidelines established a class I indication for Cardiac Resynchronization Therapy (CRT) implantation in symptomatic heart failure patients with QRS duration greater than 150 ms and complete left branch block. </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">It is known that QRS duration is influenced by weight and height, but it remains unclear if the adjustment of the QRS to these parameters can help to better select patients who respond to CRT. </span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Purpose</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: </span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">To analyze if the QRS adjusted to body mass index (BMI) and body surface area (BSA) could predict CRT response in patients with QRS < 160ms. </span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods: </strong></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Single-centre retrospective study of consecutive patients with QRS < 160ms submitted to CRT implantation between 2016 and 2019. A total of 53 CRT recipients were analyzed to assess response to CRT at 12 months of implantation based on echocardiographic criteria (responders defined as: increase of ejection fraction ≥ 10% or left ventricle end-systolic volume reduction ≥ 15%). Baseline QRS duration was adjusted to BMI (QRS/BMI) and BSA (QRS/BSA) to create and compare the best QRS index to predict CRT response, compared to non-adjusted QRS.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The results were obtained using the Mann-Whitney test and linear regression. The best cut-off for QRS/IMC and QRS/BSA index was defined using the area under the ROC curve (AUC). The significance between AUC was calculated using NCSS software. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Fifty-three patients were included (72% males, mean age 72.1 </span></span></span><span style="font-size:11pt"><span style="font-family:'Times New Roman'"><span style="color:#000000">±</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> 9.8 years), of which 26 patients (49%) responded to CRT. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The mean QRS/BSA index was higher in CRT responders compared to non-responders (82.56 </span></span></span><span style="font-size:11pt"><span style="font-family:'Times New Roman'"><span style="color:#000000">±</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> 2.74 </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><em>versus</em></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> 75.34 </span></span></span><span style="font-size:11pt"><span style="font-family:'Times New Roman'"><span style="color:#000000">±</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> 1.70, p=0.04). There was a positive linear correlation between QRS/BSA index and response to CRT (r=0.302, p=0.03). QRS/BSA index of 64.32 was the best cut-off to predict CRT response (AUC 0.66, sensitivity 96%, specificity 85%, p=0.044). </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Regarding the QRS/IMC index, there was no difference between CRT responders and non-responders (5.82 </span></span></span><span style="font-size:11pt"><span style="font-family:'Times New Roman'"><span style="color:#000000">± 0.25 and 5.29 ± 0.12, p=</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> 0.194). The best QRS/IMC cut-off to predict CRT response was 4.34 (AUC 0.61, sensitivity 96%, specificity 85%, p=0.194). </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The difference between AUC of QRS/BSA and QRS/IMC index was statistically significant (p=0.04). </span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: </span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Indexing the QRS to the BSA improves patient selection for CRT implantation and this index should be considered as a novel indicator to predict the response to CRT. There is still need further studies to validate this data. </span></span></span></p> <p> </p>
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