Kim Bong Joon, Park Han Su, Im Sung Il, Kim Hyun Su, Heo Jung Ho, Cha Tae Joon, Cho Kyoung Im
Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea.
J Cardiovasc Imaging. 2020 Oct;28(4):244-253. doi: 10.4250/jcvi.2020.0025.
Recent studies have demonstrated that angiotensin receptor neprilysin inhibitors (ARNIs) can reverse the cardiac remodeling effects that occur in heart failure with reduced ejection fraction (HFrEF). These studies have also suggested that ARNIs have favorable effects on ventricular dyssynchrony. We assessed the changes in QRS duration associated with ARNIs in patients with HFrEF.
We retrospectively investigated patients with HFrEF (defined by a left ventricular ejection fraction [LVEF] ≤ 35%) who were treated with ARNIs for at least six months. We divided the patients into QRS shortening and non-QRS shortening groups according to their electrocardiogram (ECG) findings. We also compared changes in echocardiographic parameters between the groups.
A total of 68 patients with HFrEF were included (mean age: 62.5 years, 74.6% male). Twenty-one patients had significant ischemic heart disease (IHD). Thirty-five patients exhibited QRS-duration shortening on follow-up ECGs (mean change: -7.8 msec), and 33 patients showed no changes or increased QRS duration (mean change: 5.1 msec). The QRS shortening group exhibited significant improvement in LVEF (12.5 ± 15.3% vs. 1.7 ± 9.5%; p < 0.001) when compared with the non-QRS shortening group. The QRS shortening group also had significantly lower LV end-diastolic dimension (LVEDD), LV end-systolic dimension (LVESD) and LV mass index (LVMI) than did the non-QRS shortening group. The change in QRS duration was significantly correlated with the change in LVEF (r = -0.329, p = 0.011) and LVESD (r = 0.298, p = 0.022).
Among patients with HFrEF treated with ARNIs, the QRS shortening group showed favorable LV systolic function recovery, and reversal of cardiac remodeling compared to those of the non-QRS shortening group. Change in the QRS duration, which reflects LV synchrony, may be associated with response to ARNIs in patients with HFrEF.
近期研究表明，血管紧张素受体脑啡肽酶抑制剂（ARNI）可逆转射血分数降低的心力衰竭（HFrEF）中出现的心脏重塑效应。这些研究还表明，ARNI对心室不同步有有益作用。我们评估了HFrEF患者中与ARNI相关的QRS波时限变化。
我们回顾性研究了接受ARNI治疗至少6个月的HFrEF患者（定义为左心室射血分数[LVEF]≤35%）。根据心电图（ECG）结果将患者分为QRS波时限缩短组和非QRS波时限缩短组。我们还比较了两组之间超声心动图参数的变化。
共纳入68例HFrEF患者（平均年龄：62.5岁，74.6%为男性）。21例患者患有严重缺血性心脏病（IHD）。35例患者在随访心电图上表现出QRS波时限缩短（平均变化：-7.8毫秒），33例患者QRS波时限无变化或延长（平均变化：5.1毫秒）。与非QRS波时限缩短组相比，QRS波时限缩短组的LVEF有显著改善（12.5±15.3%对1.7±9.5%；p<0.001）。QRS波时限缩短组的左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）和左心室质量指数（LVMI）也显著低于非QRS波时限缩短组。QRS波时限变化与LVEF变化（r=-0.329，p=0.011）和LVESD变化（r=0.298，p=0.022）显著相关。
在接受ARNI治疗的HFrEF患者中与非QRS波时限缩短组相比，QRS波时限缩短组显示出良好的左心室收缩功能恢复和心脏重塑逆转。反映左心室同步性的QRS波时限变化可能与HFrEF患者对ARNI的反应有关。
