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Prognostic implication of baseline PR interval in cardiac resynchronization therapy recipients

Januszkiewicz, Łukasz ; Vegh, Eszter ; Borgquist, Rasmus LU orcid ; Bose, Abhishek ; Sharma, Ajay ; Orencole, Mary ; Mela, Theofanie ; Singh, Jagmeet P and Parks, Kimberly A (2015) In Heart Rhythm 12(11). p.62-2256
Abstract

BACKGROUND: Prolongation of the baseline ECG PR interval is frequently encountered among cardiac resynchronization therapy (CRT) recipients. There are conflicting data regarding the association of a prolonged PR interval with long-term clinical outcome in this patient group.

OBJECTIVE: The purpose of this study was to compare clinical outcomes and response to CRT in patients with normal (<200 ms) vs prolonged (≥200 ms) baseline PR interval.

METHODS: In this study, 283 patients (normal PR interval: n = 158; prolonged PR interval: n = 125) with documented baseline intrinsic PR interval were followed for 3 years after CRT implantation. The study population consisted of 24.7% women (mean age 66 ± 13 years, left ventricular... (More)

BACKGROUND: Prolongation of the baseline ECG PR interval is frequently encountered among cardiac resynchronization therapy (CRT) recipients. There are conflicting data regarding the association of a prolonged PR interval with long-term clinical outcome in this patient group.

OBJECTIVE: The purpose of this study was to compare clinical outcomes and response to CRT in patients with normal (<200 ms) vs prolonged (≥200 ms) baseline PR interval.

METHODS: In this study, 283 patients (normal PR interval: n = 158; prolonged PR interval: n = 125) with documented baseline intrinsic PR interval were followed for 3 years after CRT implantation. The study population consisted of 24.7% women (mean age 66 ± 13 years, left ventricular ejection fraction 24% ± 7%).

RESULTS: A Cox proportional hazard model identified baseline PR interval as a predictor of the composite end-point (all-cause mortality, heart failure hospitalization, left ventricular assist device implantation, and heart transplantation) in univariate analysis (hazard ratio [HR] 1.49, 95% confidence interval [CI] 1.02-2.17, P = .04) but not in multivariate analysis. It also predicted heart failure hospitalization in univariate (HR 1.6, 95% CI 1.1-2.4, P = .02) and multivariate analysis (HR 1.6, 95% CI 1.0-2.3, P = .03). A prolonged PR interval was associated with lower probability of reverse remodeling defined as ≥10% improvement in ejection fraction (64% vs 77%, P = .057), especially in patients with non-left bundle branch block ECG morphology (41% vs 68%, P = .03).

CONCLUSION: Among patients with CRT, a prolonged baseline PR interval is an independent predictor of worse prognosis and lower probability of reverse remodeling, especially for patients with non-left bundle branch block morphology on ECG.

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author
; ; ; ; ; ; ; and
publishing date
type
Contribution to journal
publication status
published
keywords
Age Factors, Aged, Analysis of Variance, Bundle-Branch Block, Cardiac Resynchronization Therapy, Case-Control Studies, Electrocardiography, Electrodes, Implanted, Female, Follow-Up Studies, Heart Failure, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Multivariate Analysis, Predictive Value of Tests, Retrospective Studies, Risk Assessment, Sex Factors, Survival Rate, Treatment Outcome, Comparative Study, Journal Article, Research Support, Non-U.S. Gov't
in
Heart Rhythm
volume
12
issue
11
pages
7 pages
publisher
Elsevier
external identifiers
  • scopus:84945439473
  • pmid:26066291
ISSN
1547-5271
DOI
10.1016/j.hrthm.2015.06.016
language
English
LU publication?
no
id
30ebe57b-1833-4db6-a9a3-bf1a11ad2ed5
date added to LUP
2016-11-24 21:18:11
date last changed
2022-04-16 21:10:58
@article{30ebe57b-1833-4db6-a9a3-bf1a11ad2ed5,
  abstract     = {{<p>BACKGROUND: Prolongation of the baseline ECG PR interval is frequently encountered among cardiac resynchronization therapy (CRT) recipients. There are conflicting data regarding the association of a prolonged PR interval with long-term clinical outcome in this patient group.</p><p>OBJECTIVE: The purpose of this study was to compare clinical outcomes and response to CRT in patients with normal (&lt;200 ms) vs prolonged (≥200 ms) baseline PR interval.</p><p>METHODS: In this study, 283 patients (normal PR interval: n = 158; prolonged PR interval: n = 125) with documented baseline intrinsic PR interval were followed for 3 years after CRT implantation. The study population consisted of 24.7% women (mean age 66 ± 13 years, left ventricular ejection fraction 24% ± 7%).</p><p>RESULTS: A Cox proportional hazard model identified baseline PR interval as a predictor of the composite end-point (all-cause mortality, heart failure hospitalization, left ventricular assist device implantation, and heart transplantation) in univariate analysis (hazard ratio [HR] 1.49, 95% confidence interval [CI] 1.02-2.17, P = .04) but not in multivariate analysis. It also predicted heart failure hospitalization in univariate (HR 1.6, 95% CI 1.1-2.4, P = .02) and multivariate analysis (HR 1.6, 95% CI 1.0-2.3, P = .03). A prolonged PR interval was associated with lower probability of reverse remodeling defined as ≥10% improvement in ejection fraction (64% vs 77%, P = .057), especially in patients with non-left bundle branch block ECG morphology (41% vs 68%, P = .03).</p><p>CONCLUSION: Among patients with CRT, a prolonged baseline PR interval is an independent predictor of worse prognosis and lower probability of reverse remodeling, especially for patients with non-left bundle branch block morphology on ECG.</p>}},
  author       = {{Januszkiewicz, Łukasz and Vegh, Eszter and Borgquist, Rasmus and Bose, Abhishek and Sharma, Ajay and Orencole, Mary and Mela, Theofanie and Singh, Jagmeet P and Parks, Kimberly A}},
  issn         = {{1547-5271}},
  keywords     = {{Age Factors; Aged; Analysis of Variance; Bundle-Branch Block; Cardiac Resynchronization Therapy; Case-Control Studies; Electrocardiography; Electrodes, Implanted; Female; Follow-Up Studies; Heart Failure; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; Predictive Value of Tests; Retrospective Studies; Risk Assessment; Sex Factors; Survival Rate; Treatment Outcome; Comparative Study; Journal Article; Research Support, Non-U.S. Gov't}},
  language     = {{eng}},
  number       = {{11}},
  pages        = {{62--2256}},
  publisher    = {{Elsevier}},
  series       = {{Heart Rhythm}},
  title        = {{Prognostic implication of baseline PR interval in cardiac resynchronization therapy recipients}},
  url          = {{http://dx.doi.org/10.1016/j.hrthm.2015.06.016}},
  doi          = {{10.1016/j.hrthm.2015.06.016}},
  volume       = {{12}},
  year         = {{2015}},
}