Comparison of measures of ventricular delay on cardiac resynchronization therapy response.
Heart Rhythm
; 17(4): 615-620, 2020 04.
Article
em En
| MEDLINE
| ID: mdl-31765805
ABSTRACT
BACKGROUND:
Left ventricular (LV) pacing at sites of prolonged LV delay (QLV) or at long interventricular delay (right ventricle [RV]-LV) is strongly associated with cardiac resynchronization therapy (CRT) response. QLV and RV-LV have been independently evaluated, but little is known regarding the interrelationship between these measures or of delay to the RV.OBJECTIVE:
The purpose of this study was to evaluate the relationship between measures of electrical delay on CRT response in the SMART-AV (SmartDelay Determined AV Optimization A Comparison to Other AV Delay Methods Used in Cardiac Resynchronization Therapy) trial.METHODS:
In 419 patients, QLV and RV-LV were measured. CRT response was defined as a >15% reduction in LV end-systolic volume from implant to 6 months. The correlation between QLV and RV-LV and the clinical variables associated with the difference between QLV and RV-LV (QRV) were determined. Multivariable logistic regression was used to analyze the association between these measures on CRT response. A machine learning algorithm was used to construct a classification tree to predict response to CRT.RESULTS:
The cohort was 66% male (age 66 ± 11 years), 75% had left bundle branch block; and QRS was 150 ± 25 ms. QLV and RV-LV were highly correlated (R2 = 0.71). A longer QRV was observed among patients with right bundle branch block, ischemic cardiomyopathy, and increased QRS. In a multivariable model including QLV, RV-LV, and other known predictors of CRT response, RV-LV, but not QLV, remained associated with CRT response (odds ratio 1.13; 95% confidence interval 1.02-1.26; P = .017). Combining the 2 measures achieved better prediction of CRT response in the group with intermediate RV-LV.CONCLUSION:
RV-LV is a better predictor of CRT response than QLV. There is incremental value in using both measurements or QRV in certain subpopulations.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Bloqueio de Ramo
/
Função Ventricular Esquerda
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Remodelação Ventricular
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Eletrocardiografia
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Terapia de Ressincronização Cardíaca
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Ventrículos do Coração
Tipo de estudo:
Clinical_trials
/
Prognostic_studies
Limite:
Aged
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Female
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Humans
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Male
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article