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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,
Jazyk angličtina Země Spojené státy americké
Typ dokumentu časopisecké články, práce podpořená grantem
NLK
Free Medical Journals
od 2008 do Před 1 rokem
Open Access Digital Library
od 2008-04-01
- MeSH
- akční potenciály * MeSH
- blokáda Tawarova raménka diagnóza mortalita patofyziologie terapie MeSH
- časové faktory MeSH
- defibrilátory implantabilní * MeSH
- elektrická defibrilace škodlivé účinky přístrojové vybavení mortalita MeSH
- elektrokardiografie * MeSH
- klinické rozhodování MeSH
- lidé středního věku MeSH
- lidé MeSH
- multicentrické studie jako téma MeSH
- obnova funkce MeSH
- prediktivní hodnota testů MeSH
- randomizované kontrolované studie jako téma MeSH
- retrospektivní studie MeSH
- senioři MeSH
- srdeční frekvence MeSH
- srdeční resynchronizační terapie * škodlivé účinky mortalita MeSH
- srdeční selhání diagnóza mortalita patofyziologie terapie MeSH
- výběr pacientů MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem 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
Citace poskytuje Crossref.org
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