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Higuchi K, Manne M, Tchou P, Baranowski B, Bhargava M, Callahan T, Chung M, Dresing T, Hussein A, Kanj M, Mayuga K, Nakhla S, Saliba W, Rickard J, Wazni O, Santangeli P, Sroubek J, Varma N. Left Ventricular Mass as a Modulator of Ventricular Arrhythmia Risk and Sex Differences Following CRT for Non-Ischemic Cardiomyopathy and LBBB. Heart Rhythm 2024:S1547-5271(24)03084-4. [PMID: 39084586 DOI: 10.1016/j.hrthm.2024.07.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 07/01/2024] [Accepted: 07/13/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Risk for ventricular arrhythmias (VA) following cardiac resynchronization therapy (CRT) has been associated with ischemic disease/scar, sex, and possibly left ventricular mass (LVM). OBJECTIVE To evaluate sex differences and baseline/post-implant change [Δ] of LVM on VA risk after CRT implant among patients with non-ischemic cardiomyopathy (NICM) and left bundle branch block. METHODS Among patients meeting the criteria, baseline and follow-up echocardiographic images were obtained for LVM assessment. VA events were reported from device diagnostics and therapies. VA risk was stratified by ROC (Youden-index cut-point) for baseline LVM and ΔLVM, and baseline patient characteristics using a multivariable Cox regression model. RESULTS 118 patients (71[60.2%] female, age 60.5 ±11.3 years, LVEF 19.2 ±7.0%, QRS 165.6 ±20 ms, LVM 313.9 ±108.8 g) were enrolled and followed for median 90 (IQR 44-158) months. Thirty-five (29.6%) patients received appropriate shocks or anti-tachycardia pacing at a median of 73.5 (IQR 25-130) months post-implant. Males had a higher VA incidence (male 18/47 [38.3%] vs. female 17/71 [23.9%], P=0.02). Baseline LVM >308.9g separated patients with higher VA risk (P=0.001). Less than a 20% decrease in LVM increased VA risk (P<0.001). Baseline LVM was the only baseline characteristic predicting VA events in the Cox regression model (Hazard ratio 1.01 [95%CI, 1.001-1.009], Log-rank P=0.003). Sex differences in VA risk were eliminated by the baseline LVM parameters. CONCLUSION VA risk after CRT in NICM was associated with baseline LV >308.9g and a decrease in LVM ≤ 20%, without sex differences.
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Affiliation(s)
- Koji Higuchi
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
| | - Mahesh Manne
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Patrick Tchou
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Bryan Baranowski
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Mandeep Bhargava
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Thomas Callahan
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Mina Chung
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Thomas Dresing
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Ayman Hussein
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Mohamed Kanj
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Kenneth Mayuga
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Shady Nakhla
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Walid Saliba
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - John Rickard
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Oussama Wazni
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Pasquale Santangeli
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Jakub Sroubek
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Niraj Varma
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
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Yamamoto N, Noda T, Nakano M, Ito T, Sato H, Hayashi H, Chiba T, Hasebe Y, Ueda N, Kamakura T, Ishibashi K, Miyata S, Kusano K, Yasuda S. Clinical utility of QRS duration normalized to left ventricular volume for predicting cardiac resynchronization therapy efficacy in patients with "mid-range" QRS duration. Heart Rhythm 2024; 21:855-862. [PMID: 38367890 DOI: 10.1016/j.hrthm.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/30/2024] [Accepted: 02/09/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is effective for patients with heart failure with QRS duration (QRSd) ≥150 ms. However, its beneficial effect seems to be limited for those with "mid-range" QRSd (120-149 ms). Recent studies have demonstrated that modifying QRSd to left ventricular end-diastolic volume (LVEDV)-modified QRSd-improves the prediction of clinical outcomes of CRT. OBJECTIVE The purpose of this study was to investigate the clinical impact of the modified QRSd on the efficacy of CRT in patients with "mid-range" QRSd. METHODS We conducted a retrospective, multicenter, observational study, with heart failure hospitalization (HFH) after CRT as the primary endpoint. Modified QRSd is defined as QRSd divided by LVEDV, determined through the Teichholtz method of echocardiography. RESULTS Among the 506 consecutive patients considered, 119 (mean age 61 ± 15 years; 80% male, QRSd 135 ± 9 ms) with a "mid-range" QRSd who underwent de novo CRT device implantation were included for analysis. During median follow-up of 878 days [interquartile range 381-1663 days], HFH occurred in 45 patients (37%). Fine-Gray analysis revealed modified QRSd was an independent predictor of HFH (hazard ratio [HR] 0.97; 95% confidence interval [CI] 0.96-0.99; P <.01). Receiver operating characteristic curve analysis revealed a cutoff value of 0.65 ms/mL for the modified QRSd in predicting HFH. Patients above the threshold exhibited a significantly lower incidence of HFH than patients below the threshold (HR 0.46; 95% CI 0.25-0.86; P = .01). CONCLUSION Modified QRSd can effectively predict the efficacy of CRT in patients with a "mid-range" QRSd.
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Affiliation(s)
- Nobuhiko Yamamoto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Noda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Makoto Nakano
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomohiro Ito
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroyuki Sato
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hideka Hayashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takahiko Chiba
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yuhi Hasebe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Nobuhiko Ueda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tsukasa Kamakura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kohei Ishibashi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Miyata
- Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
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