Horizontal QRS axis predicts response to cardiac resynchronization therapy in heart failure patients with left bundle branch block

Document Type

Journal Article

Publication Title

Heart Rhythm

PubMed ID

39536809

Publisher

Elsevier

School

Centre for Precision Health / School of Medical and Health Sciences

RAS ID

76477

Funders

National Natural Science Foundation of China (82073659) / Provincial Medical Scientific Research Foundation of Guangdong (A2021084) / Provincial Science and Technology Special Fund of Guangdong (20211231071-4) / Funding for Guangdong Medical Leading Talent / First Affiliated Hospital, SUMC, China (2019\u20132022) / 2020 Li Ka Shing Foundation Cross-Disciplinary Research Grant (2020LKSFG19B) / Grant for Key Disciplinary Project of Clinical Medicine under the High-level University Development Program, Guangdong, China (2024)

Comments

Chen, Z., Chu, J., Wang, J., Cai, C., Lu, X., Song, M., ... & Tan, X. (2024). Horizontal QRS axis predicts response to cardiac resynchronization therapy in heart failure patients with left bundle branch block. Heart Rhythm. Advance online publication. https://doi.org/10.1016/j.hrthm.2024.11.011

Abstract

Background: Electrocardiogram criteria for left bundle branch block (LBBB) inadequately predict left ventricular electrical dyssynchrony, complicating cardiac resynchronization therapy (CRT) candidate selection. Objective: This study aimed to investigate the predictive value of the horizontal QRS axis for CRT response in heart failure (HF) patients with LBBB patterns. Methods: The direction and magnitude of the horizontal QRS axis were calculated using the net amplitudes in leads V2 and V6. CRT response was defined as a ≥10% increase in left ventricular ejection fraction and at least 1 New York Heart Association class reduction 1 year after CRT implantation. The composite end point included HF hospitalization or all-cause mortality. Results: Of 244 consecutive CRT recipients, 156 (63.9%) responded favorably; 88 (36.1%) were nonresponders. The horizontal QRS axis demonstrated significant backward deviation (−75.5° [−79.7° to −69.0°] vs −65.0° [−73.0° to −46.5°]; P < .001) and larger magnitude (35.5 ± 10.9 mm vs 25.5 ± 10.5 mm; P < .001) in CRT responders compared with nonresponders. The direction and magnitude independently predicted CRT response with an area under the curve of 0.778 (95% confidence interval [CI], 0.717–0.839) and 0.749 (95% CI, 0.685–0.814), respectively. Combining both parameters increased the area under the curve to 0.814 (95% CI, 0.760–0.868). Moreover, the direction and magnitude of the horizontal QRS axis, or their combination, predicted the composite end point of HF hospitalization or all-cause mortality, with hazard ratios of 0.36 (95% CI, 0.22–0.60), 0.41 (95% CI, 0.25–0.67), and 0.25 (95% CI, 0.15–0.41), respectively. Conclusion: Horizontal QRS axis accurately predicts CRT response and prognosis in HF patients with LBBB.

DOI

10.1016/j.hrthm.2024.11.011

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