A new simplified electrocardiographic score predicts clinical outcome in patients treated with CRT
(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:
https://lup.lub.lu.se/record/acfe618f-585b-40f3-9751-c01f61d38768
- author
- organization
- publishing date
- 2018-03-01
- 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
- pmid:28160485
- 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
- 2024-06-09 14:15:26
@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 < 0.001) and for ≥10% left ventricular ejection fraction improvement (OR 1.7 [1.3–2.3] P < 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}}, doi = {{10.1093/europace/euw382}}, volume = {{20}}, year = {{2018}}, }