Vectorcardiographic QRS area as a novel predictor of response to cardiac resynchronization therapy

Caroline J M van Deursen; Kevin Vernooy; Elton Dudink; Lennart Bergfeldt; Harry J G M Crijns; Frits W Prinzen; Liliane Wecke

doi:10.1016/j.jelectrocard.2014.10.003

Vectorcardiographic QRS area as a novel predictor of response to cardiac resynchronization therapy

J Electrocardiol. 2015 Jan-Feb;48(1):45-52. doi: 10.1016/j.jelectrocard.2014.10.003. Epub 2014 Oct 24.

Authors

Caroline J M van Deursen¹, Kevin Vernooy², Elton Dudink², Lennart Bergfeldt³, Harry J G M Crijns², Frits W Prinzen⁴, Liliane Wecke⁵

Affiliations

¹ Cardiovascular Research Institute Maastricht, Department of Physiology, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht, Department of Cardiology, Maastricht, the Netherlands.
² Cardiovascular Research Institute Maastricht, Department of Cardiology, Maastricht, the Netherlands.
³ Sahlgrenska Academy, Department of Molecular and Clinical Medicine/Cardiology, University of Gothenburg, Sweden.
⁴ Cardiovascular Research Institute Maastricht, Department of Physiology, Maastricht, the Netherlands. Electronic address: frits.prinzen@maastrichtuniversity.nl.
⁵ Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.

PMID: 25453196
DOI: 10.1016/j.jelectrocard.2014.10.003

Abstract

Background: QRS duration and left bundle branch block (LBBB) morphology are used to select patients for cardiac resynchronization therapy (CRT). We investigated whether the area of the QRS complex (QRSAREA) on the 3-dimensional vectorcardiogram (VCG) can improve patient selection.

Methods: VCG (Frank orthogonal lead system) was recorded prior to CRT device implantation in 81 consecutive patients. VCG parameters, including QRSAREA, were assessed, and compared to QRS duration and morphology. Three LBBB definitions were used, differing in requirement of mid-QRS notching. Responders to CRT (CRT-R) were defined as patients with ≥15% reduction in left ventricular end systolic volume after 6months of CRT.

Results: Fifty-seven patients (70%) were CRT-R. QRSAREA was larger in CRT-R than in CRT non-responders (140±42 vs 100±40 μVs, p<0.001) and predicted CRT response better than QRS duration (AUC 0.78 vs 0.62, p=0.030). With a 98μVs cutoff value, QRSAREA identified CRT-R with an odds ratio (OR) of 10.2 and a 95% confidence interval (CI) of 3.4 to 31.1. This OR was higher than that for QRS duration >156ms (OR=2.5; 95% CI 0.9 to 6.6), conventional LBBB classification (OR=5.5; 95% CI 0.9 to 32.4) or LBBB classification according to American guidelines (OR=4.5; 95% CI 1.6 to 12.6) or Strauss (OR=10.0; 95% CI 3.2 to 31.1).

Conclusion: QRSAREA is an objective electrophysiological predictor of CRT response that performs at least as good as the most refined definition of LBBB.

Condensed abstract: In 81 candidates for cardiac resynchronization therapy (CRT) we measured the area of the QRS complex (QRSAREA) using 3-dimensional vectorcardiography. QRSAREA was larger in echocardiographic responders than in non-responders and predicted CRT response better than QRS duration and than simple LBBB criteria. QRSAREA is a promising electrophysiological predictor of CRT response.

Keywords: Cardiac resynchronization therapy; QRS area; Vectorcardiography.

Publication types

Controlled Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Algorithms
Bundle-Branch Block / diagnosis*
Bundle-Branch Block / prevention & control*
Cardiac Resynchronization Therapy / methods*
Diagnosis, Computer-Assisted / methods*
Female
Humans
Male
Outcome Assessment, Health Care / methods*
Prognosis
Reproducibility of Results
Sensitivity and Specificity
Treatment Outcome
Vectorcardiography / methods*