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Responders to cardiac resynchronization therapy with narrow or intermediate QRS complexes identified by simple echocardiographic indices of dyssynchrony: The DESIRE study
Author(s) -
Cazeau Serge J.,
Daubert JClaude,
Tavazzi Luigi,
Frohlig Gerd,
Paul Vince
Publication year - 2008
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1016/j.ejheart.2008.02.007
Subject(s) - medicine , cardiac resynchronization therapy , qrs complex , cardiology , ejection fraction , heart failure , clinical endpoint , ventricular dyssynchrony , population , diastole , clinical trial , blood pressure , environmental health
Background: Cardiac resynchronization therapy (CRT) is recommended for patients with NYHA class III–IV refractory heart failure (HF), ejection fraction <35% and a QRS >120ms. We attempted to identify responders to CRT from echocardiographic (echo) indices of mechanical dyssynchrony in patients with QRS < 150 ms. Methods and results: The study enrolled 51 men and 9 women (mean age: 64.5years) in NYHA class III ( n =54) or IV ( n =6) presenting with a mean ejection fraction: 25.7%, LV end‐diastolic diameter: 69.1mm, and QRS = 121 ± 19 ms. All patients were implanted with a CRT system and followed for 1year. Implantation was preceded and followed by clinical, functional and Doppler (D)‐echo evaluation. The primary combined endpoint included 1) death from any cause, 2) HF‐related hospitalisations, and 3) NYHA class at 6 months. Before implant, 27 patients had ≥ 1 echo criterion of mechanical dyssynchrony (DES+ group) and 33 had no evidence of dyssynchrony (DES− group). At 12months, 8 patients (4 per group) had died, 7 from HF. As regards the primary endpoint at 6 months, 33 patients (55%) had improved, 10 (16%) were unchanged, and 17 (29%) had deteriorated. Clinical improvement was observed in 19 of 27 DES+ (70%), versus 14 of 33 DES− (42%) patients ( P <0.04). Baseline QRS duration did not predict response to CRT. Conclusions: In this population of HF patients with QRS < 150 ms, the presence of mechanical dyssynchrony at baseline D‐echo examination, but not the QRS width, predicted 6‐month clinical response to CRT.