Operative Unit of Cardiology - UTIC, University Hospital "Paolo Giaccone", University of Palermo, AOUP Paolo Giaccone, Via del Vespro 129, Palermo, Italy.
Operative Unit of Cardiology - UTIC, Desenzano's Hospital "ASST GARDA", Brescia, Italy.
Pacing Clin Electrophysiol. 2024 Jul;47(7):966-973. doi: 10.1111/pace.15021. Epub 2024 Jun 3.
Several studies have evaluated the role of QRS duration (QRSd) or QRS narrowing as a predictor of response to cardiac resynchronization therapy (CRT) to reduce nonresponders.
Our study aimed to determine the correlation between the relative change in QRS index (QI) compared to clinical outcome and prognosis in patients who underwent CRT implantation.
A three-centers study involving 398 patients with a CRT device was conducted. Clinical, echocardiographic and pharmacological variables, QRSd before and after CRT implantation and QI were measured.
In a 6-month follow-up, a significant improvement in left ventricular ejection fraction (LVEF), left ventricular end-diastolic and systolic volumes (LVEDV and LVESV) were observed. QI was related to reverse remodeling (multiple r-squared: 0.48, adjusted r-squared: 0.43, p = .001), and the cut-off value that best predicted LV reverse remodeling after 6 months of CRT was 12.25% (AUC 0.7, p = .001). At 24 months, a statistically significant difference was found between patients with a QI ≤ 12.25% and those with a QI > 12.25% regarding NYHA class worsening (p = .04). The mean of the QI of patients who died from cardiovascular causes was lower than patients who died of other causes (p = .0179). A correlation between pre-CRT QRSd/LVEDV and QI was observed (r = + 0.20; p = .0003). A higher QRSd/LVEDV ratio was associated with an improved LVEF, LVEDV, and LVESV (p < .0001) at follow-up.
QI narrowing after CRT was related to greater echocardiographic reverse remodeling and a lower rate of adverse events (death or cardiovascular hospitalizations). The QI can improve the prediction of adverse events in a population with CRT regardless of comorbidities according to the Charlson Comorbidity Index. QI could be used to predict CRT response.
多项研究评估了 QRS 时限（QRSd）或 QRS 变窄作为预测心脏再同步治疗（CRT）反应以减少无反应者的指标。
我们的研究旨在确定在接受 CRT 植入的患者中，与临床结果和预后相关的 QRS 指数（QI）相对变化之间的相关性。
进行了一项涉及 398 例 CRT 装置患者的三中心研究。测量了临床、超声心动图和药理学变量、CRT 植入前后的 QRSd 和 QI。
在 6 个月的随访中，观察到左心室射血分数（LVEF）、左心室舒张末期和收缩末期容积（LVEDV 和 LVESV）显著改善。QI 与逆重构相关（多元 r 平方：0.48，调整 r 平方：0.43，p=.001），6 个月 CRT 后最佳预测 LV 逆重构的截断值为 12.25%（AUC 0.7，p=.001）。在 24 个月时，QI≤12.25%的患者与 QI>12.25%的患者之间在纽约心脏协会（NYHA）分级恶化方面存在统计学差异（p=.04）。死于心血管原因的患者的 QI 平均值低于死于其他原因的患者（p=.0179）。观察到 CRT 前 QRSd/LVEDV 和 QI 之间存在相关性（r=+0.20；p=.0003）。较高的 QRSd/LVEDV 比值与随访时 LVEF、LVEDV 和 LVESV 的改善相关（p<.0001）。
CRT 后 QI 变窄与更大的超声心动图逆重构和不良事件（死亡或心血管住院）发生率降低相关。QI 可以改善根据 Charlson 合并症指数的 CRT 人群中不良事件的预测。QI 可用于预测 CRT 反应。
