Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany.
Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, TXP Medical Co. Ltd., Tokyo, Japan.
Catheter Cardiovasc Interv. 2021 Oct;98(4):E594-E601. doi: 10.1002/ccd.29505. Epub 2021 Feb 1.
While QRS duration is a known marker of left ventricular (LV) function, little is known about its utility for predicting clinical prognosis after transcatheter mitral valve repair (TMVR). We investigated the association between QRS duration and one-year adverse events after TMVR with the MitraClip system.
From January 2011 through April 2019, we identified consecutive patients who underwent TMVR. Patients who had prior cardiac resynchronization therapy or a ventricular pacing rhythm were excluded. The patients were divided into two groups according to their QRS duration (<120 or ≥ 120 ms). Cox proportional hazard model was applied to determine the association between QRS duration and the composite outcome (all-cause mortality and re-hospitalization due to heart failure) within 1 year.
A total of 348 patients were analyzed. Prolonged QRS duration (≥120 ms) was associated with an increased risk of the composite outcome (adjusted-HR 2.35, 95%CI 1.30-4.24, p = .005). There was a linear relationship between prolonged QRS duration and the increased risk of the composite outcomes. The observed association was consistent both in patients with left ventricular ejection fraction ≤35% and those with >35%. Furthermore, a QRS duration ≥120 ms was associated with lower improvement of LVEF at follow-up (adjusted-β coefficient - 5.31%, 95%CI -8.17 to -2.46, p < .001).
Prolonged QRS duration was associated with an increased risk of mortality and re-hospitalization and less improvement of LVEF following TMVR. QRS duration could be a useful marker to predict adverse outcomes and LV function after TMVR.
虽然 QRS 持续时间是左心室（LV）功能的已知标志物，但对于其在经导管二尖瓣修复（TMVR）后预测临床预后的用途知之甚少。我们研究了 QRS 持续时间与 MitraClip 系统 TMVR 后一年不良事件之间的关系。
从 2011 年 1 月至 2019 年 4 月，我们确定了连续接受 TMVR 的患者。排除了先前接受心脏再同步治疗或心室起搏节律的患者。根据 QRS 持续时间（<120 或≥120 ms）将患者分为两组。应用 Cox 比例风险模型确定 QRS 持续时间与 1 年内复合结局（全因死亡率和因心力衰竭再住院）之间的关系。
共分析了 348 例患者。QRS 持续时间延长（≥120 ms）与复合结局风险增加相关（校正 HR 2.35，95%CI 1.30-4.24，p = 0.005）。QRS 持续时间延长与复合结局风险增加之间存在线性关系。在左心室射血分数≤35%和>35%的患者中，观察到的相关性是一致的。此外，QRS 持续时间≥120 ms 与随访时 LVEF 改善程度较低相关（校正β系数-5.31%，95%CI -8.17 至-2.46，p<0.001）。
QRS 持续时间延长与 TMVR 后死亡率和再住院率增加以及 LVEF 改善程度降低相关。QRS 持续时间可能是预测 TMVR 后不良结局和 LV 功能的有用标志物。
