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Usefulness of the Sum Absolute QRST Integral to Predict Outcomes in Patients Receiving Cardiac Resynchronization Therapy

Jacobsson, Jonatan LU ; Borgquist, Rasmus LU ; Reitan, Christian LU ; Ghafoori, Elyar; Chatterjee, Neal A.; Kabir, Muammar; Platonov, Pyotr G. LU ; Carlson, Jonas LU ; Singh, Jagmeet P. and Tereshchenko, Larisa G. (2016) In American Journal of Cardiology 118(6). p.389-395
Abstract

Cardiac resynchronization therapy (CRT) reduces mortality and morbidity in selected patients with heart failure (HF), but up to 1/3 of patients are nonresponders. Sum absolute QRST integral (SAI QRST) recently showed association with mechanical response on CRT. However, it is unknown whether SAI QRST is associated with all-cause mortality and HF hospitalizations in patients undergoing CRT. The study population included 496 patients undergoing CRT (mean age 69 ± 10 years, 84% men, 65% left bundle branch block [LBBB], left ventricular ejection fraction 23 ± 6%, 63% ischemic cardiomyopathy). Preimplant digital 12-lead electrocardiogram was transformed into orthogonal XYZ electrocardiogram. SAI QRST was measured as an arithmetic sum of... (More)

Cardiac resynchronization therapy (CRT) reduces mortality and morbidity in selected patients with heart failure (HF), but up to 1/3 of patients are nonresponders. Sum absolute QRST integral (SAI QRST) recently showed association with mechanical response on CRT. However, it is unknown whether SAI QRST is associated with all-cause mortality and HF hospitalizations in patients undergoing CRT. The study population included 496 patients undergoing CRT (mean age 69 ± 10 years, 84% men, 65% left bundle branch block [LBBB], left ventricular ejection fraction 23 ± 6%, 63% ischemic cardiomyopathy). Preimplant digital 12-lead electrocardiogram was transformed into orthogonal XYZ electrocardiogram. SAI QRST was measured as an arithmetic sum of areas under the QRST curve on XYZ leads and was dichotomized based on the median value (302 mV ms). All-cause mortality served as the primary end point. A composite of 2-year all-cause mortality, heart transplant, and HF hospitalization was a secondary end point. Cox regression models were adjusted for known predictors of CRT response. Patients with preimplant low mean SAI QRST had an increased risk of both the primary (hazard ratio [HR] 1.8, 95% CI 1.01 to 3.2) and secondary (HR 1.6, 95% CI 1.1 to 2.2) end points after multivariate adjustment. SAI QRST was associated with secondary outcome in subgroups of patients with LBBB (HR 2.1, 95% CI 1.5 to 3.0) and with non-LBBB (HR 1.7, 95% CI 1.0 to 2.6). In patients undergoing CRT, preimplant SAI QRST

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
American Journal of Cardiology
volume
118
issue
6
pages
389 - 395
publisher
Excerpta Medica
external identifiers
  • scopus:84971671264
  • wos:000380867000013
ISSN
0002-9149
DOI
10.1016/j.amjcard.2016.05.017
language
English
LU publication?
yes
id
6b2f788c-7cb4-4ec2-9ced-a0e90c129887
date added to LUP
2016-06-14 14:25:59
date last changed
2017-03-10 08:18:17
@article{6b2f788c-7cb4-4ec2-9ced-a0e90c129887,
  abstract     = {<p>Cardiac resynchronization therapy (CRT) reduces mortality and morbidity in selected patients with heart failure (HF), but up to 1/3 of patients are nonresponders. Sum absolute QRST integral (SAI QRST) recently showed association with mechanical response on CRT. However, it is unknown whether SAI QRST is associated with all-cause mortality and HF hospitalizations in patients undergoing CRT. The study population included 496 patients undergoing CRT (mean age 69 ± 10 years, 84% men, 65% left bundle branch block [LBBB], left ventricular ejection fraction 23 ± 6%, 63% ischemic cardiomyopathy). Preimplant digital 12-lead electrocardiogram was transformed into orthogonal XYZ electrocardiogram. SAI QRST was measured as an arithmetic sum of areas under the QRST curve on XYZ leads and was dichotomized based on the median value (302 mV ms). All-cause mortality served as the primary end point. A composite of 2-year all-cause mortality, heart transplant, and HF hospitalization was a secondary end point. Cox regression models were adjusted for known predictors of CRT response. Patients with preimplant low mean SAI QRST had an increased risk of both the primary (hazard ratio [HR] 1.8, 95% CI 1.01 to 3.2) and secondary (HR 1.6, 95% CI 1.1 to 2.2) end points after multivariate adjustment. SAI QRST was associated with secondary outcome in subgroups of patients with LBBB (HR 2.1, 95% CI 1.5 to 3.0) and with non-LBBB (HR 1.7, 95% CI 1.0 to 2.6). In patients undergoing CRT, preimplant SAI QRST </p>},
  author       = {Jacobsson, Jonatan and Borgquist, Rasmus and Reitan, Christian and Ghafoori, Elyar and Chatterjee, Neal A. and Kabir, Muammar and Platonov, Pyotr G. and Carlson, Jonas and Singh, Jagmeet P. and Tereshchenko, Larisa G.},
  issn         = {0002-9149},
  language     = {eng},
  number       = {6},
  pages        = {389--395},
  publisher    = {Excerpta Medica},
  series       = {American Journal of Cardiology},
  title        = {Usefulness of the Sum Absolute QRST Integral to Predict Outcomes in Patients Receiving Cardiac Resynchronization Therapy},
  url          = {http://dx.doi.org/10.1016/j.amjcard.2016.05.017},
  volume       = {118},
  year         = {2016},
}