El inicio rápido de la fragmentación del QRS predice la no respuesta a la terapia de resincronización cardíaca en pacientes con insuficiencia cardíaca no isquémica / Shorter time to begin of QRS fragmentation predicts non-response to cardiac resynchronization therapy in non-ischemic heart failure patients

Objetivo: La terapia de resincronización cardíaca (TRC) es una opción eficaz en el tratamiento de los pacientes con insuficiencia cardíaca y QRS ancho. Se ha demostrado que la presencia de un QRS fragmentado (QRS-f) en el electrocardiograma (ECG) de 12 derivaciones se asocia con una no respuesta a la TRC. El objetivo de este estudio es valorar si la aparición de la fragmentación (intervalo Q-f) es importante en la respuesta a la TRC. Métodos: Análisis retrospectivo de centro único de datos recogidos de manera prospectiva procedentes de 38 pacientes con miocardiopatía isquémica dilatada (18 hombres, media de edad de 63+/-12 años) sometidos a TRC con un QRS-f en ECG de 12 derivaciones. Se midieron la duración de la fragmentación, la relación duración del QRS-f/duración total del QRS (QRS-f/QRS-t) y el intervalo de tiempo transcurrido desde la aparición de la onda Q hasta el inicio de la fragmentación del QRS. Resultados: No se observaron diferencias estadísticamente significativas entre los pacientes respondedores (24 pacientes, 63%) y los no respondedores en cuanto a las características clínicas iniciales y los hallazgos electrocardiográficos. No obstante, en pacientes no respondedores a la TRC, se observó una mayor duración del QRS-f, una proporción QRS-f/QRS-t aumentada y un intervalo Q-f más breve. En el análisis multivariante, se estableció el intervalo Q-f como un predictor independiente de respuesta a la TRC (OR 1,240; IC 95%: 1,049-1,467; p=0,012). En el análisis de curva ROC, el valor de corte para el intervalo Q-f por lo que se refiere a la predicción de respondedores fue 32,5ms, con una sensibilidad y especificidad del 83,3 y 85,7%, respectivamente (AUC 0,899, IC 95%: 0,797-1,000; p=0,001). Conclusiones: Un intervalo de tiempo breve entre el inicio de QRS y el inicio de la fragmentación es un marcador ECG sencillo para la predicción de pacientes no respondedores a la TRC

Objective: Cardiac resynchronization therapy (CRT) is an effective option in the treatment of patients with heart failure and wide QRS. Presence of fragmented QRS (f-QRS) on 12-lead electrocardiogram (ECG) has been shown to be associated with non-response to CRT. The aim of this study was to evaluate whether onset of fragmentation (Q-f interval) is important for CRT response. Methods: This is a single-center retrospective analysis of prospectively collected data of 38 non-ischemic dilated cardiomyopathy patients (18 men, mean age 63+/-12 years) with f-QRS on 12-lead ECG who underwent CRT. Duration of fragmentation, ratio of f-QRS duration to the total QRS duration (f-QRS/t-QRS ratio) and time interval from Q wave to the onset of QRS fragmentation (Q-f interval) were measured. Results: The baseline clinical, echocardiographic findings of patients with responders (24 patients, 63%) and non-responders showed no statistically significant difference, except for longer f-QRS duration, increased ratio of f-QRS duration to the total QRS duration (f-QRS/t-QRS ratio) and shorter time interval from Q wave to the onset of QRS fragmentation (Q-f interval) in patients not responding to CRT. In multivariate analysis, Q-f interval was determined as an independent predictor of response to CRT (OR 1.240, 95% CI: 1.049-1.467, P=.012). In ROC curve analysis, the best cut-off value for Q-f interval to predict responders was 32.5ms with a sensitivity and specificity of 83.3% and 85.7%, respectively (AUC 0.899, 95% CI: 0.797-1.000, P=.001). Conclusions: Shorter time from onset of QRS to beginning of fragmentation is a simple ECG marker to predict non-responsive patients to CRT

Shorter time to begin of QRS fragmentation predicts non-response to cardiac resynchronization therapy in non-ischemic heart failure patients. / El inicio rápido de la fragmentación del QRS predice la no respuesta a la terapia de resincronización cardíaca en pacientes con insuficiencia cardíaca no isquémica.

OBJECTIVE: Cardiac resynchronization therapy (CRT) is an effective option in the treatment of patients with heart failure and wide QRS. Presence of fragmented QRS (f-QRS) on 12-lead electrocardiogram (ECG) has been shown to be associated with non-response to CRT. The aim of this study was to evaluate whether onset of fragmentation (Q-f interval) is important for CRT response. METHODS: This is a single-center retrospective analysis of prospectively collected data of 38 non-ischemic dilated cardiomyopathy patients (18 men, mean age 63±12 years) with f-QRS on 12-lead ECG who underwent CRT. Duration of fragmentation, ratio of f-QRS duration to the total QRS duration (f-QRS/t-QRS ratio) and time interval from Q wave to the onset of QRS fragmentation (Q-f interval) were measured. RESULTS: The baseline clinical, echocardiographic findings of patients with responders (24 patients, 63%) and non-responders showed no statistically significant difference, except for longer f-QRS duration, increased ratio of f-QRS duration to the total QRS duration (f-QRS/t-QRS ratio) and shorter time interval from Q wave to the onset of QRS fragmentation (Q-f interval) in patients not responding to CRT. In multivariate analysis, Q-f interval was determined as an independent predictor of response to CRT (OR 1.240, 95% CI: 1.049-1.467, P=.012). In ROC curve analysis, the best cut-off value for Q-f interval to predict responders was 32.5ms with a sensitivity and specificity of 83.3% and 85.7%, respectively (AUC 0.899, 95% CI: 0.797-1.000, P=.001). CONCLUSIONS: Shorter time from onset of QRS to beginning of fragmentation is a simple ECG marker to predict non-responsive patients to CRT.

The value of serum tumour markers in the prediction of aetiology and follow up of patients with pericardial effusion.

BACKGROUND: The aim of this study was to evaluate the value of tumour markers in the differential diagnosis of pericardial effusions and to assess their changing levels during follow up. METHODS: Sixty-nine patients who were admitted to hospital with a diagnosis of pericardial effusion were included in the study. Serum tumour markers were measured on admission and after a mean of 18 ± 7 months' follow up. An aetiological diagnosis was made on clinical evaluation, imaging techniques and biochemical, microbiological and pathological analysis. The patients were divided into five groups according to the aetiology of their pericardial effusions. RESULTS: Carbohydrate antigen (CA) 12-5 and CA 15-3, and carcinoembryonic antigen (CEA) levels were significantly higher in patients with malignancies than in those with viral/idiopathic pericarditis. With multivariate analysis, CA 15-3 levels were found to be the most significant determinant (p = 0.027). In the ROC curve analysis, CA 15-3 values above 25 U/ml predicted a malignancy with 71% sensitivity and 78% specificity. CONCLUSION: Tumour markers, particularly CA 15-3, may be useful in the differential diagnosis and prediction of malignancies in patients with pericardial effusion. In patients with viral/idiopathic aetiology, these serum tumour markers were slightly elevated in the acute phase, but after a mean of one year of follow up, their levels returned to normal, contrary to those with malignancies.