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Ventricular Electrical Delay Measured From Body Surface ECGs Is Associated With Cardiac Resynchronization Therapy Response in Left Bundle Branch Block Patients From the MADIT-CRT Trial (Multicenter Automatic Defibrillator Implantation-Cardiac Resynchronization Therapy)
F. Plesinger, P. Jurak, J. Halamek, P. Nejedly, P. Leinveber, I. Viscor, V. Vondra, S. McNitt, B. Polonsky, AJ. Moss, W. Zareba, JP. Couderc,
Language English Country United States
Document type Journal Article, Research Support, Non-U.S. Gov't
NLK
Free Medical Journals
from 2008 to 1 year ago
Open Access Digital Library
from 2008-04-01
- MeSH
- Action Potentials * MeSH
- Bundle-Branch Block diagnosis mortality physiopathology therapy MeSH
- Time Factors MeSH
- Defibrillators, Implantable * MeSH
- Electric Countershock adverse effects instrumentation mortality MeSH
- Electrocardiography * MeSH
- Clinical Decision-Making MeSH
- Middle Aged MeSH
- Humans MeSH
- Multicenter Studies as Topic MeSH
- Recovery of Function MeSH
- Predictive Value of Tests MeSH
- Randomized Controlled Trials as Topic MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Heart Rate MeSH
- Cardiac Resynchronization Therapy * adverse effects mortality MeSH
- Heart Failure diagnosis mortality physiopathology therapy MeSH
- Patient Selection MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
BACKGROUND: Although cardiac resynchronization therapy (CRT) is beneficial in heart failure patients with left bundle branch block, 30% of these patients do not respond to the therapy. Identifying these patients before implantation of the device is one of the current challenges in clinical cardiology. METHODS: We verified the diagnostic contribution and an optimized computerized approach to measuring ventricular electrical activation delay (VED) from body surface 12-lead ECGs. We applied the method to ECGs acquired before implantation (baseline) in the MADIT-CRT trial (Multicenter Automatic Defibrillator Implantation-Cardiac Resynchronization Therapy). VED values were dichotomized using its quartiles, and we tested the association of VED values with the MADIT-CRT primary end point of heart failure or death. Multivariate Cox proportional models were used to estimate the risk of study end points. In addition, the association between VED values and hemodynamic changes after CRT-D implantation was examined using 1-year follow-up echocardiograms. RESULTS: Our results showed that left bundle branch block patients with baseline VED <31.2 ms had a 35% risk of MADIT-CRT end points, whereas patients with VED ≥31.2 ms had a 14% risk (P<0.001). The hazard ratio for predicting primary end points in patients with low VED was 2.34 (95% confidence interval, 1.53-3.57; P<0.001). Higher VED values were also associated with beneficial hemodynamic changes. These strong VED associations were not found in the right bundle branch block and intraventricular conduction delay cohorts of the MADIT-CRT trial. CONCLUSIONS: Left bundle branch block patients with a high baseline VED value benefited most from CRT, whereas left bundle branch block patients with low VED did not show CRT benefits.
Heart Research Follow up Program University of Rochester Medical Center NY
International Clinical Research Center St Anne's University Hospital Brno Czech Republic
The Czech Academy of Sciences Institute of Scientific Instruments Department of Medical Signals Brno
References provided by Crossref.org
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