SPC365

QRS narrowing predicts left ventricular reverse remodelling after resynchronization therapy in patients with end-stage heart failure

Session: Posters - C. Arrhythmias and Device Therapy
Speaker: Tamara Pereira

Congress: CPC 2021
Topic: C. Arrhythmias and Device Therapy
Theme: 09. Device Therapy
Subtheme: 09.3 Cardiac Resynchronization Therapy
Session Type: Posters
FP Number: ---
Authors: Tamara Pereira; Pedro Von Hafe Leite; Geraldo Dias; Ana Filipa Cardoso; Mariana Tinoco; Olga Azevedo; Filipa Cordeiro; Sílvia Ribeiro; Francisco Ferreira; Víctor Sanfins; António Lourenço

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">INTRODUCTION: &nbsp;Cardiac resynchronization therapy (CRT) is an established treatment for heart failure (HF) patients, however </span></span><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">one-third of the patients fail to benefit from CRT</span></span></span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">. The relationship between the QRS duration, severity of mechanical dyssynchrony and efficacy of CRT is not completely understood. We determined if QRS duration shortening after CRT implantation was predictive of left ventricular reverse remodelling.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">METHODS: &nbsp;We retrospectively enrolled 227 patients undergoing CRT implantation between 2013 and 2020 according to the <em>guidelines. </em></span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">88 patients were included in our analysis, from whom all data were available. </span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Clinical, electrocardiographic and echocardiographic parameters were evaluated at baseline and after 6 months of CRT implantation. Response to CRT was defined as a reduction in left ventricular end-diastolic volume (LVEDV) &gt; 15%. Linear regression models were used.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">RESULTS: &nbsp;88 patients were included (mean age 69 &plusmn; 10 years, 62.5% males, 36.4% ischemic etiology). Baseline left ventricular ejection fraction (LVEF) was 27,5 &plusmn; 5,8 % and LVEDV was 181 &plusmn; 69 ml.&nbsp; After 6 months of CRT, 52 patients (59.1%) were considered responders.&nbsp; Baseline LVEDV was superior in responders when compared with non responders (199 &plusmn; 85 ml vs 168 &plusmn; 53 ml, p= 0.038). </span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">No significant differences were noted in male gender (p=0.823), ischemic cardiomyopathy (p= 0.065), </span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">LVEF (p=0.853), atrial fibrillation (p=0.390), left bundle branch block (p=0.950) or biventricular pacing (p=0.154) between them. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">QRS duration at baseline was similar between responders and non-responders (165 &plusmn; 17 ms vs 163 &plusmn; 17 ms, p=0.620). After 6 months of CRT, the reduction of QRS duration in responders was significantly higher than non-responders (p&lt;0.001).<br />
QRS duration was reduced from 165 &plusmn; 17 ms to 136 &plusmn; 15 ms in responders <em>vs</em> 163 &plusmn; 17 ms to 160 &plusmn; 17 ms in non-responders, (p&lt; 0.001). The change in </span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">QRS duration positively correlated with the change in LVEDV (R=0. 654; p &lt; 0.001). &nbsp;<span style="background-color:white"><span style="color:black">Multi-linear regression analysis suggested that QRS duration shortening had a significant effect on LVEDV (y = 14,375 + 1.354 X, R<sup>2 </sup>0.337, p&lt;0.001)</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">CONCLUSION: QRS duration shortening after CRT implantation was predictive of LV reverse remodelling in end-stage heart failure patients. Further prospective studies should be conducted to assess the prognostic value of QRS narrowing in response to CRT.</span></span></span></span></p>