Advanced

A new simplified electrocardiographic score predicts clinical outcome in patients treated with CRT

Végh, Eszter M; Kandala, Jagdesh; Januszkiewicz, Lukasz; Ren, Jen; Miller, Alexandra; Orencole, Mary; Blendea, Dan; Merkely, Béla; Gellér, László and Singh, Jagmeet P, et al. (2018) In Europace 20(3). p.492-500
Abstract
Aims

Cardiac Resynchronization Therapy (CRT) reduces morbidity and mortality for patients with heart failure and wide QRS complex, but up to 1/3 of patients are "non-responders" to the therapy. This study examines the ability of a simple standard electrocardiogram (ECG)-based scoring system to predict clinical outcome.
Methods and results

Four hundred and ninety-one consecutive patients with CRT-implants (79% males, mean age 71 years, LVEF 24%, 59% with ischemic cardiomyopathy, 83% in NYHA class III) were included from a single large volume centre. All patients met standard indications for CRT, and were followed for 3 years after CRT implantation. Three ECG parameters were measured on the post-implant ECG, and... (More)
Aims

Cardiac Resynchronization Therapy (CRT) reduces morbidity and mortality for patients with heart failure and wide QRS complex, but up to 1/3 of patients are "non-responders" to the therapy. This study examines the ability of a simple standard electrocardiogram (ECG)-based scoring system to predict clinical outcome.
Methods and results

Four hundred and ninety-one consecutive patients with CRT-implants (79% males, mean age 71 years, LVEF 24%, 59% with ischemic cardiomyopathy, 83% in NYHA class III) were included from a single large volume centre. All patients met standard indications for CRT, and were followed for 3 years after CRT implantation. Three ECG parameters were measured on the post-implant ECG, and compared to pre-implantation measurements: QRS duration, time to intrinsicoid deflection onset (ID) in V1 lead, amplitude change in V1 lead. Each positive ECG variable was given a numerical value of 1 to create the score (ranging 0–3). Clinical outcome was assessed as a composite of all-cause death, left ventricular assist device implantation, cardiac transplantation and HF hospitalization. Event-free survival was predicted by shortening of QRS duration ≥20 ms (HR 0.66 [95% CI 0.48–0.90] P = 0.009), ≥50% decreased summed R + S amplitude in V1 lead (HR 0.67 [0.49–0.90] P = 0.009) and ≤40 msec ID time in lead V1 during pacing (HR 0.63 [0.46–0.86] P = 0.004). The total score was an independent predictor for both event-free survival (HR 0.65 [0.54–0.77] P < 0.001) and for ≥10% left ventricular ejection fraction improvement (OR 1.7 [1.3–2.3] P < 0.001).
Conclusions

Composite data from 12-lead ECG during CRT-treatment can be used in a simple score to predict long-term clinical outcome. (Less)
Please use this url to cite or link to this publication:
author
, et al. (More)
(Less)
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Europace
volume
20
issue
3
pages
492 - 500
publisher
Oxford University Press
external identifiers
  • scopus:85043239452
ISSN
1532-2092
DOI
10.1093/europace/euw382
language
English
LU publication?
yes
id
acfe618f-585b-40f3-9751-c01f61d38768
date added to LUP
2017-04-07 15:12:07
date last changed
2018-05-29 10:19:23
@article{acfe618f-585b-40f3-9751-c01f61d38768,
  abstract     = {Aims<br>
<br>
Cardiac Resynchronization Therapy (CRT) reduces morbidity and mortality for patients with heart failure and wide QRS complex, but up to 1/3 of patients are "non-responders" to the therapy. This study examines the ability of a simple standard electrocardiogram (ECG)-based scoring system to predict clinical outcome.<br>
Methods and results<br>
<br>
Four hundred and ninety-one consecutive patients with CRT-implants (79% males, mean age 71 years, LVEF 24%, 59% with ischemic cardiomyopathy, 83% in NYHA class III) were included from a single large volume centre. All patients met standard indications for CRT, and were followed for 3 years after CRT implantation. Three ECG parameters were measured on the post-implant ECG, and compared to pre-implantation measurements: QRS duration, time to intrinsicoid deflection onset (ID) in V1 lead, amplitude change in V1 lead. Each positive ECG variable was given a numerical value of 1 to create the score (ranging 0–3). Clinical outcome was assessed as a composite of all-cause death, left ventricular assist device implantation, cardiac transplantation and HF hospitalization. Event-free survival was predicted by shortening of QRS duration ≥20 ms (HR 0.66 [95% CI 0.48–0.90] P = 0.009), ≥50% decreased summed R + S amplitude in V1 lead (HR 0.67 [0.49–0.90] P = 0.009) and ≤40 msec ID time in lead V1 during pacing (HR 0.63 [0.46–0.86] P = 0.004). The total score was an independent predictor for both event-free survival (HR 0.65 [0.54–0.77] P &lt; 0.001) and for ≥10% left ventricular ejection fraction improvement (OR 1.7 [1.3–2.3] P &lt; 0.001).<br>
Conclusions<br>
<br>
Composite data from 12-lead ECG during CRT-treatment can be used in a simple score to predict long-term clinical outcome.},
  author       = {Végh, Eszter M and Kandala, Jagdesh and Januszkiewicz, Lukasz and Ren, Jen and Miller, Alexandra and Orencole, Mary and Blendea, Dan and Merkely, Béla and Gellér, László and Singh, Jagmeet P and Borgquist, Rasmus},
  issn         = {1532-2092},
  language     = {eng},
  month        = {03},
  number       = {3},
  pages        = {492--500},
  publisher    = {Oxford University Press},
  series       = {Europace},
  title        = {A new simplified electrocardiographic score predicts clinical outcome in patients treated with CRT},
  url          = {http://dx.doi.org/10.1093/europace/euw382},
  volume       = {20},
  year         = {2018},
}