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Vectorcardiographic QRS area is associated with long-term outcome after cardiac resynchronization therapy.

Publication ,  Journal Article
Emerek, K; Friedman, DJ; Sørensen, PL; Hansen, SM; Larsen, JM; Risum, N; Thøgersen, AM; Graff, C; Kisslo, J; Søgaard, P; Atwater, BD
Published in: Heart Rhythm
February 2019

BACKGROUND: Recent studies have suggested that vectorcardiographic measures predict left ventricular (LV) reverse remodeling and clinical outcome in patients receiving cardiac resynchronization therapy (CRT). OBJECTIVES: The objectives of this study were to compare predictive abilities of different vectorcardiographic measures (QRS area and sum absolute QRS-T integral) and transformation methods (Kors and inverse Dower) and to assess the independent association between the best predictor and outcomes in CRT recipients. METHODS: This retrospective study included CRT recipients with a digital baseline electrocardiogram, QRS duration ≥120 ms, and ejection fraction ≤35%. The end point was a composite of heart transplantation, LV assist device implantation, or all-cause death. Analyses were performed for the overall cohort and for a prespecified subgroup of patients with left bundle branch block (LBBB). RESULTS: Of 705 included patients with a mean age of 66.6 ± 11.5 years, 492 (70%) were men, 374 (53%) had ischemic heart disease, and 465 (66%) had LBBB. QRS area from vectorcardiograms derived via the Kors transformation demonstrated the best predictive value. In multivariable Cox regression, patients with a smaller QRS area (≤ 95 μVs) had an increased hazard in the overall cohort (adjusted hazard ratio 1.65; 95% CI 1.25-2.18 P < .001) and in the LBBB subgroup (adjusted hazard ratio 1.95; 95% CI 1.38-2.76 P < .001). QRS area was associated with outcome in patients with QRS duration <150 ms (unadjusted hazard ratio 3.85; 95% CI 2.02-7.37 P < .001) and in patients with QRS duration ≥150 ms (unadjusted hazard ratio 1.76; 95% CI 1.32-2.34 P < .001). CONCLUSION: Vectorcardiographic QRS area is associated with survival free from heart transplantation and LV assist device implantation in CRT recipients.

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Published In

Heart Rhythm

DOI

EISSN

1556-3871

Publication Date

February 2019

Volume

16

Issue

2

Start / End Page

213 / 219

Location

United States

Related Subject Headings

  • Ventricular Remodeling
  • Ventricular Function, Left
  • Vectorcardiography
  • Treatment Outcome
  • Time Factors
  • Stroke Volume
  • Retrospective Studies
  • Reproducibility of Results
  • Male
  • Humans
 

Citation

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ICMJE
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Emerek, K., Friedman, D. J., Sørensen, P. L., Hansen, S. M., Larsen, J. M., Risum, N., … Atwater, B. D. (2019). Vectorcardiographic QRS area is associated with long-term outcome after cardiac resynchronization therapy. Heart Rhythm, 16(2), 213–219. https://doi.org/10.1016/j.hrthm.2018.08.028
Emerek, Kasper, Daniel J. Friedman, Peter Lyngø Sørensen, Steen Møller Hansen, Jacob Moesgaard Larsen, Niels Risum, Anna Margrethe Thøgersen, et al. “Vectorcardiographic QRS area is associated with long-term outcome after cardiac resynchronization therapy.Heart Rhythm 16, no. 2 (February 2019): 213–19. https://doi.org/10.1016/j.hrthm.2018.08.028.
Emerek K, Friedman DJ, Sørensen PL, Hansen SM, Larsen JM, Risum N, et al. Vectorcardiographic QRS area is associated with long-term outcome after cardiac resynchronization therapy. Heart Rhythm. 2019 Feb;16(2):213–9.
Emerek, Kasper, et al. “Vectorcardiographic QRS area is associated with long-term outcome after cardiac resynchronization therapy.Heart Rhythm, vol. 16, no. 2, Feb. 2019, pp. 213–19. Pubmed, doi:10.1016/j.hrthm.2018.08.028.
Emerek K, Friedman DJ, Sørensen PL, Hansen SM, Larsen JM, Risum N, Thøgersen AM, Graff C, Kisslo J, Søgaard P, Atwater BD. Vectorcardiographic QRS area is associated with long-term outcome after cardiac resynchronization therapy. Heart Rhythm. 2019 Feb;16(2):213–219.
Journal cover image

Published In

Heart Rhythm

DOI

EISSN

1556-3871

Publication Date

February 2019

Volume

16

Issue

2

Start / End Page

213 / 219

Location

United States

Related Subject Headings

  • Ventricular Remodeling
  • Ventricular Function, Left
  • Vectorcardiography
  • Treatment Outcome
  • Time Factors
  • Stroke Volume
  • Retrospective Studies
  • Reproducibility of Results
  • Male
  • Humans