CLINICAL RESEARCH
Long-term effectiveness of cardiac resynchronization therapy in patients with refractory heart failure and "narrow" QRS
Augusto Achilli, MD*,*,
Massimo Sassara, MD*,
Sabina Ficili, MD*,
Daniele Pontillo, MD*,
Paola Achilli, MD*,
Claudio Alessi, MD*,
Stefano De Spirito, MD*,
Roberto Guerra, MD*,
Nicolino Patruno, MD and
Francesco Serra, MD*
* Cardiovascular Department, Belcolle Hospital, Viterbo, Italy
Cardiology Division, S.Giuseppe Hospital, Albano Laziale, Italy
Manuscript received August 20, 2002;
revised manuscript received August 13, 2003,
accepted August 19, 2003.
* Reprint requests and correspondence: Dr. Augusto Achilli, Cardiovascular Department, Belcolle Hospital, Via Monfalcone, 20/A, 01100 Viterbo, Italy.
aachilli{at}libero.it
OBJECTIVES: The aim of the study was to evaluate the effectiveness of cardiac resynchronization therapy (CRT) in patients with refractory heart failure (HF) and incomplete left bundle branch block ("narrow" QRS), together with echocardiographic evidence of interventricular and intraventricular asynchrony.
BACKGROUND: Cardiac resynchronization therapy has been proven effective in patients with HF and wide QRS by ameliorating contraction asynchrony.
METHODS: Fifty-two patients with severe HF received biventricular pacing. The patients were eligible in the presence of echocardiographic evidence of interventricular and intraventricular asynchrony, regardless of QRS duration. The patient population was divided into group 1 (n = 38), with a QRS duration >120 ms, and group 2 (n = 14), with a QRS duration  120 ms.
RESULTS: The baseline parameters considered in the study were similar in both groups. At follow-up, CRT determined narrowing of the QRS interval in the entire population and in group 1 (p < 0.001), whereas a small increase in QRS duration was observed in group 2 (p = NS); in all patients and within groups, we observed improvement of New York Heart Association functional class (p < 0.001 in all), left ventricular ejection fraction (p < 0.001 in all), left ventricular end-diastolic and end-systolic diameter (p < 0.05 within groups), mitral regurgitation area (p < 0.001 in all), interventricular delay (p < 0.001 in all), and deceleration time (group 1: p < 0.001, group 2: p < 0.05), with no significant difference between groups. The 6-min walking test improved in both groups (group 1: p < 0.001; group 2: p < 0.01).
CONCLUSIONS: Cardiac resynchronization therapy determined clinical and functional benefit that was similar in patients with wide or "narrow" QRS. Cardiac resynchronization therapy may be helpful in patients with echocardiographic evidence of interventricular and intraventricular asynchrony and incomplete left bundle branch block.
|
Abbreviations and Acronyms
| | ACE | = angiotensin-converting enzyme | | AV | = atrioventricular | | CRT | = cardiac resynchronization therapy | | DCM | = dilated cardiomyopathy | | DT | = deceleration time | | E-A | = left ventricular filling time | | ECG | = electrocardiogram | | EF | = ejection fraction | | HF | = heart failure | | IVD | = interventricular delay | | LBBB | = left bundle branch block | | LVEDD | = left ventricular end-diastolic diameter | | LVESD | = left ventricular end-systolic diameter | | MR | = mitral regurgitation | | NYHA | = New York Heart Association | | PM | = pacemaker | | SR | = sinus rhythm | | Q-E | = Q-wave–transmitral filling E-wave interval | | Q-LW | = posterolateral left ventricular wall activation delay | | 6MWT | = 6-min walking test |
|
This article has been cited by other articles:
|
|
|
|
 
F. Eberhardt, M. Heringlake, M. S. Massalme, A. Dyllus, M. Misfeld, H.-H. Sievers, U. K.H. Wiegand, and T. Hanke
The effect of biventricular pacing after coronary artery bypass grafting: A prospective randomized trial of different pacing modes in patients with reduced left ventricular function.
J. Thorac. Cardiovasc. Surg.,
June 1, 2009;
137(6):
1461 - 1467.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. M. Hawkins, M. C. Petrie, M. I. Burgess, and J. J.V. McMurray
Selecting patients for cardiac resynchronization therapy: the fallacy of echocardiographic dyssynchrony.
J. Am. Coll. Cardiol.,
May 26, 2009;
53(21):
1944 - 1959.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Gorcsan III and M. S. Suffoletto
The role of tissue Doppler and strain imaging in predicting response to CRT
Europace,
November 1, 2008;
10(suppl_3):
iii80 - iii87.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Chen, J. J. Bax, M. M. Henneman, M. J. Boogers, and E. V. Garcia
Is nuclear imaging a viable alternative technique to assess dyssynchrony?
Europace,
November 1, 2008;
10(suppl_3):
iii101 - iii105.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. L. Zaret
Cardiac imaging and cardiac resynchronization therapy: time to get in phase.
J. Am. Coll. Cardiol. Img.,
September 1, 2008;
1(5):
614 - 616.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M Marciniak, B Bijnens, A Baltabaeva, A Marciniak, C Parsai, P Claus, and G R Sutherland
Interventricular interaction as a possible mechanism for the presence of a biphasic systolic velocity profile in normal left ventricular free walls
Heart,
August 1, 2008;
94(8):
1058 - 1064.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Abraham and T. P. Abraham
Is echocardiographic assessment of dyssynchrony useful to select candidates for cardiac resynchronization therapy?: Echocardiography Is Useful Before Cardiac Resynchronization Therapy if QRS Duration Is Available
Circ Cardiovasc Imaging,
July 1, 2008;
1(1):
79 - 85.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Chattopadhyay, M. F. Alamgir, N. P. Nikitin, A. G. Fraser, A. L. Clark, and J. G.F. Cleland
The effect of pharmacological stress on intraventricular dyssynchrony in left ventricular systolic dysfunction
Eur J Heart Fail,
April 1, 2008;
10(4):
412 - 420.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Auricchio and F. F. Faletra
Mechanical dyssynchrony in CRT patients: Still searching for the Holy Grail!
Eur J Heart Fail,
March 1, 2008;
10(3):
217 - 219.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. J. Cazeau, J-C. Daubert, L. Tavazzi, G. Frohlig, and V. Paul
Responders to cardiac resynchronization therapy with narrow or intermediate QRS complexes identified by simple echocardiographic indices of dyssynchrony: The DESIRE study
Eur J Heart Fail,
March 1, 2008;
10(3):
273 - 280.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. A. Kass
An epidemic of dyssynchrony: but what does it mean?
J. Am. Coll. Cardiol.,
January 1, 2008;
51(1):
12 - 17.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. F. Beshai, R. A. Grimm, S. F. Nagueh, J. H. Baker II, S. L. Beau, S. M. Greenberg, L. A. Pires, P. J. Tchou, and the RethinQ Study Investigators
Cardiac-Resynchronization Therapy in Heart Failure with Narrow QRS Complexes
N. Engl. J. Med.,
December 13, 2007;
357(24):
2461 - 2471.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. W. Kimmel, N. D. Skadsberg, C. L. Byrd, D. J. Wright, T. G. Laske, and P. A. Iaizzo
Single-site ventricular and biventricular pacing: investigation of latest depolarization strategy
Europace,
December 1, 2007;
9(12):
1163 - 1170.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Z. Emkanjoo, M. Esmaeilzadeh, N. Mohammad Hadi, A. Alizadeh, M. Tayyebi, and M.A. Sadr-ameli
Frequency of inter- and intraventricular dyssynchrony in patients with heart failure according to QRS width
Europace,
December 1, 2007;
9(12):
1171 - 1176.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Tabrizi, A. Englund, M. Rosenqvist, L. Wallentin, and U. Stenestrand
Influence of left bundle branch block on long-term mortality in a population with heart failure
Eur. Heart J.,
October 2, 2007;
28(20):
2449 - 2455.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Authors/Task Force Members, P. E. Vardas, A. Auricchio, J.-J. Blanc, J.-C. Daubert, H. Drexler, H. Ector, M. Gasparini, C. Linde, F. B. Morgado, et al.
Guidelines for cardiac pacing and cardiac resynchronization therapy: The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in Collaboration with the European Heart Rhythm Association
Europace,
October 1, 2007;
9(10):
959 - 998.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Authors/Task Force Members, P. E. Vardas, A. Auricchio, J.-J. Blanc, J.-C. Daubert, H. Drexler, H. Ector, M. Gasparini, C. Linde, F. B. Morgado, et al.
Guidelines for cardiac pacing and cardiac resynchronization therapy: The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in Collaboration with the European Heart Rhythm Association
Eur. Heart J.,
September 2, 2007;
28(18):
2256 - 2295.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. H. Hohnloser and E. N. Prystowsky
CRT-D use in heart failure: too little or too much?
Eur. Heart J. Suppl.,
September 1, 2007;
9(suppl_G):
G9 - G16.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. N. Kirkpatrick, M. A. Vannan, J. Narula, and R. M. Lang
Echocardiography in Heart Failure: Applications, Utility, and New Horizons
J. Am. Coll. Cardiol.,
July 31, 2007;
50(5):
381 - 396.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. A. McAlister, J. Ezekowitz, N. Hooton, B. Vandermeer, C. Spooner, D. M. Dryden, R. L. Page, M. A. Hlatky, and B. H. Rowe
Cardiac Resynchronization Therapy for Patients With Left Ventricular Systolic Dysfunction: A Systematic Review
JAMA,
June 13, 2007;
297(22):
2502 - 2514.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C.-M. Yu, Q. Zhang, and J. W.-H. Fung
Reply
J. Am. Coll. Cardiol.,
May 8, 2007;
49(18):
1900 - 1900.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. B. Bleeker, M. J. Schalij, and J. J. Bax
Reply
J. Am. Coll. Cardiol.,
May 8, 2007;
49(18):
1899 - 1900.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. D. Burkhardt and B. L. Wilkoff
Interventional Electrophysiology and Cardiac Resynchronization Therapy: Delivering Electrical Therapies for Heart Failure
Circulation,
April 24, 2007;
115(16):
2208 - 2220.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. D'Andrea, P. Caso, S. Cuomo, R. Scarafile, G. Salerno, G. Limongelli, G. Di Salvo, S. Severino, L. Ascione, P. Calabro, et al.
Effect of dynamic myocardial dyssynchrony on mitral regurgitation during supine bicycle exercise stress echocardiography in patients with idiopathic dilated cardiomyopathy and 'narrow' QRS
Eur. Heart J.,
April 2, 2007;
28(8):
1004 - 1011.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. E. Weyman
The Year in Echocardiography
J. Am. Coll. Cardiol.,
March 20, 2007;
49(11):
1212 - 1219.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. H. Schoenfeld
Contemporary Pacemaker and Defibrillator Device Therapy: Challenges Confronting the General Cardiologist
Circulation,
February 6, 2007;
115(5):
638 - 653.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C.-M. Yu, Q. Zhang, G. W.K. Yip, P.-W. Lee, L. C.C. Kum, Y.-Y. Lam, and J. W.-H. Fung
Diastolic and Systolic Asynchrony in Patients With Diastolic Heart Failure: A Common But Ignored Condition
J. Am. Coll. Cardiol.,
January 2, 2007;
49(1):
97 - 105.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. E. Sanderson
Systolic and Diastolic Ventricular Dyssynchrony in Systolic and Diastolic Heart Failure
J. Am. Coll. Cardiol.,
January 2, 2007;
49(1):
106 - 108.
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. P. Badano, O. Gaddi, C. Peraldo, G. Lupi, M. Sitges, F. Parthenakis, S. Molteni, M. R. Pagliuca, B. Sassone, P. Di Stefano, et al.
Left ventricular electromechanical delay in patients with heart failure and normal QRS duration and in patients with right and left bundle branch block
Europace,
January 1, 2007;
9(1):
41 - 47.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C.-M. Yu, Y.-S. Chan, Q. Zhang, G. W.K. Yip, C.-K. Chan, L. C.C. Kum, L. Wu, A. P.-W. Lee, Y.-Y. Lam, and J. W.-H. Fung
Benefits of Cardiac Resynchronization Therapy for Heart Failure Patients With Narrow QRS Complexes and Coexisting Systolic Asynchrony by Echocardiography
J. Am. Coll. Cardiol.,
December 5, 2006;
48(11):
2251 - 2257.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. B. Bleeker, E. R. Holman, P. Steendijk, E. Boersma, E. E. van der Wall, M. J. Schalij, and J. J. Bax
Cardiac Resynchronization Therapy in Patients With a Narrow QRS Complex
J. Am. Coll. Cardiol.,
December 5, 2006;
48(11):
2243 - 2250.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Lieberman, L. Padeletti, J. Schreuder, K. Jackson, A. Michelucci, A. Colella, W. Eastman, S. Valsecchi, and D. A. Hettrick
Ventricular Pacing Lead Location Alters Systemic Hemodynamics and Left Ventricular Function in Patients With and Without Reduced Ejection Fraction
J. Am. Coll. Cardiol.,
October 17, 2006;
48(8):
1634 - 1641.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Lafitte, P. Bordachar, M. Lafitte, S. Garrigue, S. Reuter, P. Reant, K. Serri, V. Lebouffos, M. Berrhouet, P. Jais, et al.
Dynamic Ventricular Dyssynchrony: An Exercise-Echocardiography Study
J. Am. Coll. Cardiol.,
June 6, 2006;
47(11):
2253 - 2259.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. D'Andrea, P. Caso, S. Severino, S. Cuomo, G. Capozzi, P. Calabro, G. Cice, L. Ascione, M. Scherillo, and R. Calabro
Prognostic value of intra-left ventricular electromechanical asynchrony in patients with hypertrophic cardiomyopathy
Eur. Heart J.,
June 1, 2006;
27(11):
1311 - 1318.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Mele, G. Pasanisi, F. Capasso, A. De Simone, M.-A. Morales, D. Poggio, A. Capucci, G. Tabacchi, L. Sallusti, and R. Ferrari
Left intraventricular myocardial deformation dyssynchrony identifies responders to cardiac resynchronization therapy in patients with heart failure
Eur. Heart J.,
May 1, 2006;
27(9):
1070 - 1078.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. J. Bax, T. Abraham, S. S. Barold, O. A. Breithardt, J. W.H. Fung, S. Garrigue, J. Gorcsan III, D. L. Hayes, D. A. Kass, J. Knuuti, et al.
Cardiac Resynchronization Therapy: Part 2--Issues During and After Device Implantation and Unresolved Questions
J. Am. Coll. Cardiol.,
December 20, 2005;
46(12):
2168 - 2182.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Kashani and S. S. Barold
Significance of QRS Complex Duration in Patients With Heart Failure
J. Am. Coll. Cardiol.,
December 20, 2005;
46(12):
2183 - 2192.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G.-Y. Cho, J.-K. Song, W.-J. Park, S.-W. Han, S.-H. Choi, Y.-C. Doo, D.-J. Oh, and Y. Lee
Mechanical Dyssynchrony Assessed by Tissue Doppler Imaging Is a Powerful Predictor of Mortality in Congestive Heart Failure With Normal QRS Duration
J. Am. Coll. Cardiol.,
December 20, 2005;
46(12):
2237 - 2243.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. P. Pham, S. Balaji, I. Shen, R. Ungerleider, X. Li, and D. J. Sahn
Impact of Conventional Versus Biventricular Pacing on Hemodynamics and Tissue Doppler Imaging Indexes of Resynchronization Postoperatively in Children With Congenital Heart Disease
J. Am. Coll. Cardiol.,
December 20, 2005;
46(12):
2284 - 2289.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Dohi, M. Suffoletto, S. Murali, R. Bazaz, and J. Gorcsan
Benefit of cardiac resynchronization therapy to a patient with a narrow QRS complex and ventricular dyssynchrony identified by tissue synchronization imaging
Eur J Echocardiogr,
December 1, 2005;
6(6):
455 - 460.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Berberian, T. A. Quinn, J. P. Kanter, L. J. Curtis, S. E. Cabreriza, A. D. Weinberg, and H. M. Spotnitz
Optimized Biventricular Pacing in Atrioventricular Block After Cardiac Surgery
Ann. Thorac. Surg.,
September 1, 2005;
80(3):
870 - 875.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. J. Bax and M. J. Schalij
How to predict response to cardiac resynchronization therapy?
Eur. Heart J.,
June 1, 2005;
26(11):
1054 - 1055.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. B. Curtis
Cardiac resynchronization therapy 101: If it's not late, pacing it early won't help
J. Am. Coll. Cardiol.,
January 4, 2005;
45(1):
70 - 71.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C M Yu, J J Bax, M Monaghan, and P Nihoyannopoulos
Echocardiographic evaluation of cardiac dyssynchrony for predicting a favourable response to cardiac resynchronisation therapy
Heart,
December 1, 2004;
90(suppl_6):
vi17 - vi22.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Gasparini, P. Galimberti, S. Simonini, and E. Gronda
Cardiac resynchronization therapy in patients with narrow QRS
J. Am. Coll. Cardiol.,
November 16, 2004;
44(10):
2096 - 2096.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Achilli, M. Sassara, D. Pontillo, N. Patruno, and P. Achilli
Reply
J. Am. Coll. Cardiol.,
November 16, 2004;
44(10):
2096 - 2097.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. A. McPherson and C. Manthous
Permanent Pacemakers and Implantable Defibrillators: Considerations for Intensivists
Am. J. Respir. Crit. Care Med.,
November 1, 2004;
170(9):
933 - 940.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Garrigue and H. Bader
Prognostic value of left ventricular dyssynchrony in patients with heart failure: Reply
J. Am. Coll. Cardiol.,
August 18, 2004;
44(4):
937 - 938.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. J. Bax, G. Ansalone, O. A. Breithardt, G. Derumeaux, C. Leclercq, M. J. Schalij, P. Sogaard, M. St. John Sutton, and P. Nihoyannopoulos
Echocardiographic evaluation of cardiac resynchronization therapy: ready for routine clinical use?: A critical appraisal
J. Am. Coll. Cardiol.,
July 7, 2004;
44(1):
1 - 9.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A Auricchio and C M Yu
Beyond the measurement of QRS complex toward mechanical dyssynchrony: cardiac resynchronisation therapy in heart failure patients with a normal QRS duration
Heart,
May 1, 2004;
90(5):
479 - 481.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
O. A Breithardt, P. Claus, and G. R Sutherland
Do we understand who benefits from resynchronisation therapy?
Eur. Heart J.,
April 1, 2004;
25(7):
535 - 536.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Auricchio and W. T. Abraham
Cardiac Resynchronization Therapy: Current State of the Art: Cost Versus Benefit
Circulation,
January 27, 2004;
109(3):
300 - 307.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. T. Willerson and D. J. Kereiakes
Cardiac Resynchronization Therapy: Helpful Now in Selected Patients With CHF
Circulation,
January 27, 2004;
109(3):
308 - 309.
[Full Text]
[PDF]
|
|
|
|
