Raj Ajay, Nath Ranjit Kumar, Pandit Bhagya Narayan, Singh Ajay Pratap, Pandit Neeraj, Aggarwal Puneet
Department of Cardiology, Atal Bihari Vajpayee Institute of Medical Sciences AND Dr. Ram Manohar Lohia Hospital, New Delhi, India.
Resident, Department of Cardiology, Atal Bihari Vajpayee Institute of Medical Sciences AND Dr. Ram Manohar Lohia Hospital, New Delhi, India.
ARYA Atheroscler. 2021 Sep;17(5):1-8. doi: 10.22122/arya.v17i0.2247.
Wider QRS duration and presence of left bundle branch block (LBBB) predict better cardiac resynchronization therapy (CRT) response. Despite strict patient selection, one-third of patients have a sub-optimal response. We aim to evaluate the impact of lead one ratio (LOR) on CRT response.
We enrolled 93 patients receiving CRT from August 2016 to August 2019. Pre-implant 12-lead electrocardiogram (ECG) was recorded, and LOR was derived by dividing the maximum positive deflection of QRS complex in ECG lead I by the maximum negative deflection in lead I; cut-off value of 12 was used to divide the cohort into two groups. Patients were followed for 6 months, and outcomes were compared for CRT response, New York Heart Association (NYHA) class improvement, all-cause mortality, and heart failure (HF) hospitalization events.
At the end of 6-month follow-up, LOR ≥ 12 was associated with significantly better CRT response (75.76% vs. 51.85% in LOR < 12, P = 0.02), lower mortality per 100 patient-years (9.09 vs. 14.81 in LOR < 12, P = 0.012), and more improvement in HF symptoms (NYHA improvement) (78.79% vs. 55.56% in LOR < 12, P = 0.02). Patients with LOR < 12 had more HF hospitalization events (2.04 vs. 1.81 episodes in LOR ≥ 12, P = 0.029) and less QRS narrowing (∆5.74 ± 2.09 vs. ∆7.10 ± 3.97 ms in LOR ≥ 12, P = 0.01). QRS duration and LBBB morphology were predictors of response in both groups of patients.
LOR ≥ 12 was associated with better response to CRT, less HF hospitalization, and more relief in HF symptoms. This ratio helps to identify possible sub-optimal response among patients with an indication for CRT.
更宽的QRS波时限和左束支传导阻滞（LBBB）的存在预示着心脏再同步治疗（CRT）反应更好。尽管进行了严格的患者选择，但仍有三分之一的患者反应欠佳。我们旨在评估导联一比（LOR）对CRT反应的影响。
我们纳入了2016年8月至2019年8月期间接受CRT治疗的93例患者。记录植入前的12导联心电图（ECG），通过将ECG导联I中QRS波群的最大正偏转除以导联I中的最大负偏转得出LOR；使用截断值12将队列分为两组。对患者进行6个月的随访，并比较CRT反应、纽约心脏协会（NYHA）心功能分级改善情况、全因死亡率和心力衰竭（HF）住院事件等结果。
在6个月随访结束时，LOR≥12与显著更好的CRT反应相关（LOR≥12组为75.76%，LOR<12组为51.85%，P = 0.02），每100患者年更低的死亡率（LOR<12组为9.0⑨，LOR≥12组为14.81，P = 0.012），以及HF症状（NYHA分级改善）更多的改善（LOR<12组为55.56%，LOR≥12组为78.79%，P = 0.02）。LOR<12的患者有更多的HF住院事件（LOR≥12组为1.81次发作，LOR<12组为2.04次发作，P = 0.⑩9），且QRS波变窄更少（LOR≥12组为∆7.10±3.9⑦ms，LOR<12组为∆5.74±2.0⑨ms，P = 0.01）。QRS波时限和LBBB形态是两组患者反应的预测因素。
LOR≥12与更好的CRT反应、更少的HF住院以及更多的HF症状缓解相关。该比值有助于识别有CRT指征患者中可能的欠佳反应。
