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T‐Wave Area Predicts Response to Cardiac Resynchronization Therapy in Patients with Left Bundle Branch Block
Author(s) -
ENGELS ELIEN B.,
VÉGH ESZTER M.,
DEURSEN CAROLINE J.M.,
VERNOOY KEVIN,
SINGH JAGMEET P.,
PRINZEN FRITS W.
Publication year - 2015
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.12549
Subject(s) - medicine , left bundle branch block , cardiology , cardiac resynchronization therapy , ejection fraction , qrs complex , heart failure , electrocardiography , bundle branch block
T‐Wave Predicts CRT Response in LBBB Patients Introduction Chronic heart failure patients with a left ventricular (LV) conduction delay, mostly due to left bundle branch block (LBBB), generally derive benefit from cardiac resynchronization therapy (CRT). However, 30–50% of patients do not show a clear response to CRT. We investigated whether T‐wave analysis of the ECG can improve patient selection. Methods and Results The study population comprised 244 CRT recipients with baseline 12‐lead electrocardiogram recordings. Echocardiographic response after 6‐month CRT was defined as a ≥5% increase in LV ejection fraction (LVEF). Vectorcardiograms (VCGs) were constructed from the measured 12‐lead ECGs using an adapted Kors algorithm on digitized ECGs. Logistic regression models indicated repolarization variables as good predictors of CRT response. The VCG‐derived T‐wave area predicted CRT response (odds ratio [OR] per 10 μVs increase 1.172 [P < 0.001]) even better than QRS‐wave area (OR = 1.116 [P = 0.001]). T‐wave area had especially predictive value in the LBBB patient group (OR = 2.77 in LBBB vs. 1.09 in non‐LBBB). This predictive value persisted after adjustment of multiple covariates, such as gender, ischemia, age, hypertension, coronary artery bypass graft, and the usage of diuretics and β‐blockers. In LBBB patients, the increase in LVEF was 6.1 ± 9.7% and 11.3 ± 9.1% in patients with T‐wave area below and above the median value, respectively (P < 0.01). Conclusion In patients with LBBB morphology of the QRS complex, a larger baseline T‐wave area is an important independent predictor of LVEF increase following CRT.