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Lead one ratio in left bundle branch block predicts poor cardiac resynchronization therapy response.
Pacing and Clinical Electrophysiology ( IF 1.7 ) Pub Date : 2020-05-08 , DOI: 10.1111/pace.13916
Zak Loring 1, 2 , Daniel J Friedman 1, 2 , Kasper Emerek 1, 3 , Claus Graff 4 , Peter L Sørensen 4 , Steen M Hansen 5 , Bjorn Wieslander 6 , Martin Ugander 6 , Peter Søgaard 3 , Brett D Atwater 1
Affiliation  

BACKGROUND A low electrocardiogram (ECG) lead one ratio (LOR) of the maximum positive/negative QRS amplitudes is associated with lower left ventricular ejection fraction (LVEF) and worse outcomes in left bundle branch block (LBBB); however, the impact of LOR on cardiac resynchronization therapy (CRT) outcomes is unknown. We compared clinical outcomes and echocardiographic changes after CRT implantation by LOR. METHODS Consecutive CRT-defibrillator recipients with LBBB implanted between 2006 and 2015 at Duke University Medical Center were included (N = 496). Time to heart transplant, left ventricular assist device (LVAD) implantation, or death was compared among patients with LOR <12 vs ≥12 using Cox-proportional hazard models. Changes in LVEF and LV volumes after CRT were compared by LOR. RESULTS Baseline ECG LOR <12 was associated with an adjusted hazard ratio (HR) of 1.69 (95% CI: 1.12-2.40, P = .01) for heart transplant, LVAD, or death. Patients with LOR <12 had less reduction of LV end diastolic volume (ΔLVEDV -4 ± 21 vs -13 ± 23%, P = .04) and LV end systolic volume (ΔLVESV -9 ± 27 vs -22 ± 26%, P = .03) after CRT. In patients with QRS duration (QRSd) ≥150 ms, LOR <12 was associated with an adjusted HR of 2.01 (95% CI 1.21-3.35, P = .008) for heart transplant, LVAD, or death, compared with LOR ≥12. CONCLUSIONS Baseline ECG LOR <12 portends worse outcomes after CRT implantation in patients with LBBB, specifically among those with QRSd ≥150 ms. This ECG ratio may identify patients with a class I indication for CRT implantation at high risk for poor postimplantation outcomes.

中文翻译:

左束支传导阻滞中的前导一比值预示心脏再同步治疗反应不良。

背景:最大正/负QRS振幅的低心电图导联比(LOR)与较低的左心室射血分数(LVEF)和左束支传导阻滞(LBBB)的预后不良有关。然而,LOR对心脏再同步治疗(CRT)结果的影响尚不清楚。我们比较了LOR植入CRT后的临床结局和超声心动图变化。方法纳入2006年至2015年在杜克大学医学中心植入LBBB的连续CRT除颤器接受者(N = 496)。使用Cox比例风险模型比较LOR <12 vs≥12的患者的心脏移植时间,左心室辅助装置(LVAD)植入或死亡时间。通过LOR比较CRT后LVEF和LV体积的变化。结果基线心电图LOR < 12例与心脏移植,LVAD或死亡相关的调整后的危险比(HR)为1.69(95%CI:1.12-2.40,P = .01)。LOR <12的患者左室舒张末期容积(ΔLVEDV-4±21 vs -13±23%,P = .04)和左室收缩末期容积(ΔLVESV-9±27 vs -22±26%,P = .03)。在QRS持续时间(QRSd)≥150ms的患者中,与LOR≥12相比,心脏移植,LVAD或死亡的LOR <12与校正后的HR为2.01(95%CI 1.21-3.35,P = 0.008)相关。 。结论LBBB患者,特别是QRSd≥150 ms的患者,基线ECG LOR <12表示CRT植入后预后较差。该ECG比率可以识别出I级适应症的患者,其CRT植入后植入后预后不良的风险很高。01)用于心脏移植,LVAD或死亡。LOR <12的患者左室舒张末期容积(ΔLVEDV-4±21 vs -13±23%,P = .04)和左室收缩末期容积(ΔLVESV-9±27 vs -22±26%,P = .03)。在QRS持续时间(QRSd)≥150ms的患者中,与LOR≥12相比,心脏移植,LVAD或死亡的LOR <12与校正后的HR为2.01(95%CI 1.21-3.35,P = 0.008)相关。 。结论LBBB患者,尤其是QRSd≥150 ms的患者,在CRT植入后基线ECG LOR <12表示预后较差。该ECG比率可以识别出I级适应症的患者,其CRT植入后植入后预后不良的风险很高。01)用于心脏移植,LVAD或死亡。LOR <12的患者左室舒张末期容积(ΔLVEDV-4±21 vs -13±23%,P = .04)和左室收缩末期容积(ΔLVESV-9±27 vs -22±26%,P = .03)。在QRS持续时间(QRSd)≥150ms的患者中,与LOR≥12相比,心脏移植,LVAD或死亡的LOR <12与校正后的HR为2.01(95%CI 1.21-3.35,P = 0.008)相关。 。结论LBBB患者,尤其是QRSd≥150 ms的患者,基线ECG LOR <12表示CRT植入后预后较差。该ECG比率可以识别出I级适应症的患者,其CRT植入后植入后预后不良的风险很高。04)和CRT后左室收缩末期容积(ΔLVESV-9±27 vs -22±26%,P = .03)。在QRS持续时间(QRSd)≥150ms的患者中,与LOR≥12相比,心脏移植,LVAD或死亡的LOR <12与校正后的HR为2.01(95%CI 1.21-3.35,P = 0.008)相关。 。结论LBBB患者,尤其是QRSd≥150 ms的患者,基线ECG LOR <12表示CRT植入后预后较差。该ECG比率可以识别出I级适应症的患者,其CRT植入后植入结果不良的风险很高。04)和CRT后左室收缩末期容积(ΔLVESV-9±27 vs -22±26%,P = .03)。在QRS持续时间(QRSd)≥150ms的患者中,与LOR≥12相比,心脏移植,LVAD或死亡的LOR <12与校正后的HR为2.01(95%CI 1.21-3.35,P = 0.008)相关。 。结论LBBB患者,特别是QRSd≥150 ms的患者,基线ECG LOR <12表示CRT植入后预后较差。该ECG比率可以识别出I级适应症的患者,其CRT植入后植入结果不良的风险很高。12表明在CRT植入后LBBB患者,特别是QRSd≥150ms的患者预后较差。该ECG比率可以识别出I级适应症的患者,其CRT植入后植入结果不良的风险很高。12表明在CRT植入后LBBB患者,特别是QRSd≥150ms的患者预后较差。该ECG比率可以识别出I级适应症的患者,其CRT植入后植入结果不良的风险很高。
更新日期:2020-05-08
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