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Prognostic implication of baseline PR interval in cardiac resynchronization therapy recipients

Januszkiewicz, Łukasz; Vegh, Eszter; Borgquist, Rasmus LU ; 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
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
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
2017-10-22 05:22:32
@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},
  keyword      = {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},
  volume       = {12},
  year         = {2015},
}